Patient Forms

With your busy schedule, we know your time is valuable and no one likes long waits at the doctor’s office. So to help minimize your wait time at F. Read Hopkins Pediatric Associates, please fill out the forms below in advance and bring them to your appointment. Remember, we are here for you, so please call us with any questions you may have regarding these forms. We look forward to your visit with us.

1. Patient Registration Packet
   Patient Registration Packet
2. Patient Registration Packet – 18 Years or Older
   Patient Registration Packet – 18 Years or Older
3. Patient Registration Form
   Patient Registration
4. Patient Registration Form – 18 Years or Older
   Patient Registration Form – 18 Years or Older
5. Consent Form
   Consent Form
6. Notice of Privacy Practices
   Notice of Privacy Practices
7. NPP Acknowledgement
   NPP Acknowledgement
8. Records Release Form
   PHI Authorization Form
9. School Entrance Form
   School Entrance Form
10. Sports Physical Form
    Sports Physical Form

ADHD Forms

• NICHQ Vanderbilt  Initial Assessment Scale – Parent
• NICHQ Vanderbilt Initial Assessment Scale – Teacher
• NICHQ Vanderbilt Assessment Follow-up – Parent
• NICHQ Vanderbilt Assessment Follow-up – Teacher
• Adult ADHD Self–Report Scale