When visiting a new pediatrician, it can be hard to fill out paperwork with a child on your hands. That’s why we have provided most of our patient forms below. Feel free to complete these forms prior to your appointment and return them to the office in-person, by mail, or by fax.
If you are a current patient, we have compiled additional forms you may need throughout the year. If you have any questions about our patient forms, our Fort Collins pediatric team is always available to provide the answers you need.
Ages and Stages Questionnaires
Closely monitoring developmental progress in infants, toddlers, and school-age children is one of our most important jobs. We screen children at every wellness visit from two months of age until they are five years old using the ASQ standardized testing tool. After age five, development is monitored through our discussions during wellness visits.
Prior to each of your child’s well-care visits, please log into the ASQ website online and fill out the screening questionnaire appropriate to your child’s age. Once it is submitted, it will be scored and incorporated into your child’s medical record. Your provider will review the results with you at the well-care visit. If you have any questions, please contact us.
This ASQ link is also incorporated into our free mobile app! Search for “PANC” in your app store and download it today to get started.
Allergy Evaluation Forms
Please print out the following form and bring it to your allergy consultation visit.
We offer allergy skin testing for environmental and airborne allergens. If necessary, we can follow up with sublingual immunotherapy drops to specifically target and treat the allergies we detect through skin testing.
Prior to allergy skin testing, please discontinue any antihistamine medications seven days prior to your child’s testing visit. Check our list of all antihistamines and contact us if you have any questions. (Note: sometimes antihistamines are also used for migraines or nausea, so check the list even if you do not think your child is being treated for allergies.)
Please fill out this form with as much information as you can and drop it off or email a scanned version to our office. We will return the completed form in about 48-72 hours.
- Poudre School District Medication Form
- Authorization Form for another person to bring your child in for care (grandparent, nanny, friend, etc.)
- Authorization Form to transfer records to Pediatric Associates from another office
- Authorization Form to transfer records to another office from Pediatric Associates
- PSD Jr High Sports Authorization Form
- PSD Sr High Sports Authorization Form
Attention Deficit Hyperactivity Disorder (ADHD) Evaluation forms:
Please drop these off to our office prior to your child’s ADHD evaluation.