Health Forms
Please read this entire page and make sure you have all the documents necessary for your initial appointment, if you have any questions don't hesitate in calling,
206-518-8938
All patients willl need to fill out the following and bring into their first visit:
- for you to read and then sign the reciept
Then download and fill out the Appropriate Health Questionnaire:
(One of the following: Developmental Questionnaire, General Pediatric Questionnaire)
Questionnaire for Children with Autism & Related Developmental and/or Attention Problems
ATTENTION PARENTS: THIS INTAKE FORM MUST BE RECEIVED IN OUR OFFICE 10 DAYS PRIOR TO YOUR INITIAL VISIT. IF WE DO NOT RECEIVE THE INTAKE FORM 10 DAYS PRIOR WE WILL HAVE TO RESCHEDULE YOUR VISIT. The reason for this is ensure adequate time to enter your child’s data into our computer charting system and for both a comprehensive review of your child’s history and an individualized treatment plan. THANK YOU in advance for taking the time to be thorough in relating your child’s history and I look forward to meeting you and your child.
Please download the Developmental Questionnaire and fill out in
WORD and then email it back to
: vitalfamilymedicine@gmail.com
Other Forms (Please note if you fill out the Developmental Questionnaire you DO NOT need to fill out either one of these)
General Practice Pediatric Questionnaire : please fill out in WORD and email to our office 10 days before your initial visit.
Well Child/ Short General Pediatric Intake form:
I realize there a lot of forms and some redundancy, these allow for informed treatment and optimal communication about your health care needs. I look forward to meeting you and your family!