FORMS

New Patients

Registration (Spanish Version)

Medical History (Spanish Version)

Medical Records Release Authorization

Circumcision Information
 

To View Our Notice of Privacy Practices Click Here

Ages & Stages Questionnaires

Click here to choose your child's age
ADHD

If you are interested in having your child evaluated for ADHD, print these forms.  Complete the parent's version and have your child's teacher complete the teacher's version.  Once these forms are recieved, we can setup an appointment for you child.

Parent's Vanderbilt Form (Initial Evaluation)

Teacher's Vanderbilt Form (Initial Evaluation)

For ADHD follow up appointments use these forms:

Parent's Vanderbilt Form (Follow Up)

Teacher's Vanderbilt Form (Follow Up)

Concerned About Autism

Complete this survey and bring it to your appointment, so your provider can discuss your concerns with you.

M-CHAT

Sports Physical Form

This form must be complete and brought with you at the time of the physical.

Pre Participation History Form

Pre Participation History Form Spanish

School Physical Forms

Physical Form

Physical Form (Spanish Version)

Eye Chart

Depression Screen

Depression Screen PHQ-9

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MORGANTON

828-433-4484

LENOIR

828-758-9177

VALDESE

828-874-4293

Staff Email        *         Employee Time Clock

After Hours  1-877-514-9245  *  Poision Control 1-800-222-1222