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12 Month Old Milestones 15 Month Old Milestones 18 Month Old Milestones 2 Month Old Milestones 24 Month Old Milestons 36 Month Old Milestones 4 Month Old Milestones 48 Month Old Mileston 6 Month Old Milestone 60 Month Old Milestones 9 Month Old Milestones Abnormal Involuntary Movement Scale (AIMS) Adult ADHD Form Adult Anxiety scale Adult depression questionnaire Bed wetting Child ADD/ADHD Demo Adult Demo Child Depression screening (Child) Headache Intake KHSAA COVID-19 Return to play Narrative description of child (parent) New Patient Information New Patient Information Pediatric health assessment form - 11 to 14 years Pediatric health assessment form - 2 to 3 years Pediatric health assessment form - 4 to 5 years Pediatric health assessment form - 6 to 10 years Pediatric health assessment form-15 to 18 years Pediatric health assessment 15-18 months Pediatric health assessment 19-23 months Pediatric health assessment 2-4 months Pediatric health assessment 5-7 months Pediatric health assessment 8-14 months Pediatric Symptom Checklist Youth 12-17 Pediatric Symptom Checklist Youth 6-11 PHQ- 9: Modified for Teens Record Release (from us) Request of Prior Records Screen for Child Anxiety Related Disorders (SCARED) (to be filled out by parent/guardian) Suicide Risk Screen ASQ tool

Adult depression questionnaire

Patient name *

date of birth *

Over the past 2 weeks how often have you been bothered by any of the following problems?

0= not at all 1=several days 2=more than half the days 3=nearly every day

Little interest or pleasure in doing things

Feeling down, depressed, or hopeless

Trouble falling or staying asleep, or sleeping too much

Feeling tired or having little energy

Poor appetite or overeating

Feeling bad about yourself, or that you are a failure, or have let yourself or your family down

Trouble concentrating on things, such as reading the newspaper or watching TV

Moving or speaking so slowly that other people could have noticed

Being so fidgety or restless that you have been moving around a lot more than usual.

Thoughts that you would be better off dead or of hurting yourself in some way

How difficult have any of these problems made it for you to do your work, take care of things at home, or get along with other people?

Electronic signature of patient over the age of 18 *

Today's date *

* Required field