Behavioral Management
Evaluation Forms
It's time to take a closer look...
If you've been observing behavior or seeing symptoms that concern you, then it's time to check in with us. We've included several forms below that will help us to evaluate what's happening with your child. Just print off the form that applies and take time to complete it. For those who have a portal account, call us and we will forward the appropriate forms. Then, make an appointment and bring the form with you so we can sit down together to discuss your concerns and make a plan to deal with the situation.
There are times when we will want to discuss mental health issues with school or other providers. Please fill out this Mental Health Release Form and mail/bring to the office.
You will need Adobe Reader to view the forms below. You can download a free version at www.adobe.com.
All Evaluation Forms:
Well-Child Visit Check List
Print and complete this Well-Child Visit Check-List PDF (343 Kb), then bring it with you to each well-child visit. Not all questions may pertain to your child.
Depression Evaluation
If you are concerned that your child may be depressed, let’s talk. He/she may be spending more time alone, or not doing well in school. If this is a concern, please print and complete the appropriate form(s).
Anxiety Evaluation
Children experience anxious feelings, but if you think that your child is having a hard time adjusting to new situations, or is having trouble under pressure, they may need support and we would like to help. Please print and complete the appropriate evaluation form(s), then bring them to your next visit.
Autism Screening
The American Academy of Pediatrics now recommends screening of all children for Autism at ages 18-months and 2 years of age. Prior to these visits, please print andcomplete the Autism Screening Form PDF (11.73 Kb), and then bring to your next visit.
Post-Partum Depression
We are acutely aware that many of our mothers are having a hard time after having a baby. Please print and fill out this Post-Partum Depression Evaluation PDF (65.58 Kb), then bring it to your child’s next appointment if this is a concern.
Attention-Deficit/Hyperactivity
Many of our patients have symptoms of Attention Deficit Disorder, Hyperactivity Disorder, or a combination of both. Therapies such as behavioral management and/or addition of medication will be appropriate. It is important to perform an evaluation to make sure that we have diagnosed our patients accurately and thus are able to treat them appropriately.
After being diagnosed with ADD or ADHD
It is important to re-evaluate our treatment modalities; whether it is behavioral, medication, or a combination of both. Please download, print out, and mail the following forms. We need a form from a parent who lives with your child as well as forms filled out by each of the teachers who may best know your child. We would like these forms prior to seeing your child in our office so that we have time to evaluate the forms and your child's chart.
Please keep in mind that:
We need a form from a parent who lives with your child as well as forms filled out by each of the teachers who may best know your child.
We would like these forms prior to seeing your child in our office so that we have time to evaluate the forms and your child's chart.
Not all children need to be on medication.
Attention-Deficit/Hyperactivity Evaluation Forms:
First Time Evaluation for Parents
First Time Evaluation for Teachers
