Forms

📄 Current Patient Registration to be completed by parent or guardian
(Fillable form can be downloaded, edited with Adobe Reader and printed. Then bring to the office with you)
Must be completed annually or when there has been a change to insurance.

📄 New Patient Medical History Form – To be completed by all NEW patients.

📄 18 Years and Over Patient Information

📄 Transferring from Bright Future Pediatrics Medical Records Release

📄 Release of Medical Records to Bright Future Pediatrics

📄 HIPAA Form for Patients Over 18

📄 HIPAA-Notice of Privacy Practices

📄 Controlled Substance Medication Agreement

📄 Preventative Health Exam for Kindergarten, 6th & 9th Grades

📄  Middle School Sports Form 

📄  High School Sports Forms

📄 Vanderbilt Parent Follow Up

📄 Vanderbilt Teacher Initial Assessment

📄 Vanderbilt Teacher Follow Up

📄 Patient Health Questionnaire for Depression

📄 Anxiety Disorders – Parent (Only to be completed by parent, without child input.)

📄 Anxiety Disorders – Child (Only to be completed by child, without parent input.)