When visiting a new pediatrician, it is often difficult to spend time filling out paperwork with a child on your hands. That’s why we have provided most of our patient forms below. Please feel free to complete these in advance of 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. Our Fort Collins pediatric team is always available to answer any additional questions on our patient forms..
Ages and Stages Questionnaires (ASQs)
Close monitoring of developmental progress in infants, toddlers and school age children is one of our most important jobs. We screen children at every Wellness Visit from 2 months until 5 years of age using the ASQ standardized testing tool. After age 5, 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 on-line and fill out the screening 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!
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. We follow this with sub-lingual immunotherapy drops targeted specifically to treat just the allergies we detect through skin testing.
Prior to allergy skin testing, please discontinue any antihistamine medications 7 days prior to your child’s testing visit. Here is a list of all antihistamines.
(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 this form out completely and drop it off or email a scanned version to our office. Allow 48-72 hours for completion.
- Poudre School District Medication Form
- Authorization Form for another person to bring your child in for care (grandparent, nanny, friend)
- Authorization Form to transfer records to Pediatric Associates from another office
- Authorization Form to transfer records from Pediatric Associates to another office
- 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.