Please help us provide the best care possible to your child! The forms below can greatly facilitate your examination or examination of your child. Please go over the list and complete the ones that best apply to your case. Thank you, again, for choosing Pediatric Health Care at Newton Wellesley.
ATTENTION AND BEHAVIORAL DIFFICULTIES
If your child or student is presenting primarily with attention and behavioral difficulties, please take some time and fill out the Vanderbilt Parent Scale. Please also ask your child’s teacher to complete the Vanderbilt Teacher Scale. Thank you!
Vanderbilt ADHD Parent Scale, Medication Followup & Questionnaire
Vanderbilt ADHD Teacher Scale
Vanderbilt - Parent
If your child is presenting primarily with depression and/or anxiety, please fill out the Johns Hopkins Depression Checklist, NIMH Depression Scale and/or Screen for Child Anxiety Related Disorders. Thank you!
- Johns Hopkins Depression Checklist
- NIMH Depression Scale
- Screen for Child Anxiety Related Disorders (SCARED-PARENT)
- Screen for Child Anxiety Related Disorders (SCARED-CHILD)
NEW PATIENT & NEW DEVELOPEMENT
If your child is a new patient, welcome! We are thrilled to know you entrust Pediatric Health Care with your child. Please download and print the following forms to be brought with you at your initial appointment. You can also fax them to our office in advance. The fax number is (781) 772-1497.
The Australian Scale for Asperger or the Autism Quotient Test are for minors and adults presenting primarily with social-communication difficulties. Please fill out both forms completely. Your attention to detail is greatly appreciated.
- Glasgow Anti-Psychotic Side-effect Scale
In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.