Parent Resources and Office Policies

Parenting Help

Our Health Library information does not replace the advice of a doctor. Please be advised that this information is made available to assist our patients to learn more about their health. Our providers may not see and/or treat all topics found herein.

As parents, especially if this is your first child, you always have questions and concerns. Our For Parents section is here to try and help address some of the more common issues we are often asked as pediatricians.

Pediatric Health Library
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Online Resources

Forms & Policies

To view the forms listed below, you will need Adobe Reader. Please bring your completed forms with you to our office at the time of your visit.

Appointments

Most appointment forms or consents required for visits should be completed electronically before your child’s visit. You will receive a text or email before your appointment to do so.

• Modified Checklist for Autism in Toddlers (MCHAT): We ask that families the MCHAT  screening tool to assess risk for Autism Spectrum Disorder (ASD) before the 18 and 24 month check-up appointment.
• Behavioral Health Intake Form: We ask that you complete this form prior to your first appointment with a behavioral health therapist. A parent/guardian must be present at the initial intake, even for patients who can drive themselves to the appointment. For patients 5 years and younger, we request that only the parent(s) attend the intake without the child present.
• Screen for Child Anxiety (Parent)
• Screen for Child Anxiety (Child)
• TB Screening Form
• Ohio Lead Questions
• AHP Flu Vaccine Waiver

Sports & School Forms

Various camps, sports associations, and schools require participation forms. Anderson Hills Pediatrics has an increased demand for forms to complete during summer. We always want this process to go smoothly for you and your family.

Forms can vary by school district and organization. We encourage you to confirm what forms are needed by your child’s school, daycare, athletic league, or camp.

If it has been less than 13 months since your child’s last check-up, we can complete the form based on their previous visit without additional appointments. However, the form will expire 13 months following your child’s last check-up.

To ensure the accuracy of the forms we complete, we request that the form’s parent or child portions be completed before submission. Also, please be sure to sign all fields.

Your child’s primary pediatrician will need to complete the form. If your primary care physician is out of the office, we will have to wait until they are back in the office to sign the form. The standard form turnaround is 3 to 4 business days to account for this. If you need a form completed more quickly, we will do so in 1 to 2 business days for $5.00.

Sports Forms

Ohio and Kentucky require a sports physical form to be on file with the school before the first practice.

• Ohio High School Athletic Association – 2023-2024
• Kentucky High School Athletic Association – Middle School
• Kentucky High School Athletic Association – High School

School Forms

• School Daycare Release
• Medication Form: Often your child’s school will require a form completed by their pediatrician to have medication given by the school’s personnel. The medications that most often require forms are those prescribed for ADHD, inhalers, EpiPens, and over-the-counter medications. These forms may be obtained from your child’s school.

Medical Records

Vaccination Records: If your child is up-to-date on their vaccines, you can quickly obtain a copy of their vaccination records through their patient portal.

• Records Release Authorization
• New Patient Registration Form
• Eighteen Years and Older Release Form
• Consent Treatment of Minors
• Notice of Privacy Practices
• PermissiontoPickUpScripts
• E-prescribing Consent Form
• Email Update Form

ADHD

• Vanderbilt Parent Follow-Up Form
• Vanderbilt Teacher Follow-Up Form

NOTE: Please do not fill out the Vanderbilt Teacher/Parent Follow-Up forms if your child has not been in for an Initial ADD/ADHD appointment.  You NEED to call the office and we will send you Initial Vanderbilt Forms to fill out.

New Patient Forms

For your convenience, we have posted the forms that New Patients will be asked to complete when you visit one of our offices. These forms are available in PDF format and are available for you to download, print, and complete before coming to the office. By completing forms ahead of time, you can minimize the amount of time you spend at our office

All patients under the age of 18 and new to the practice MUST be accompanied by a parent or legal guardian for their first visit.

Additional Forms