Forms & Policies

Access important forms, office policies, and patient information. We encourage you to review these documents to better understand your visit, billing, and care experience with Pediatric Affiliates.

PATIENT FORMS

Access forms designed to simplify your child's care.

Patient forms are available to download and review at any time. To safeguard your child’s protected health information (PHI), please avoid sending completed forms through unsecured email or other non-secure channels.

Patient Health Questionnaire (PHQ-9) for Depression

Screen for Child Anxiety Related Disorders

Parent Vanderbilt Forms

Teacher Vanderbilt Forms

Parent Vanderbilt Forms - Español

Teacher Vanderbilt Forms - Español

Signature on File Form

Records Release Form

Authorization to Obtain Records Form

Permission to Medicate Form

POLICIES

Ensure a smooth and informed care experience.

At Pediatric Affiliates, we want you to feel informed and confident in your child’s care. Below are the policies that guide how we partner with families. Our policies help outline what you can expect from us and what we ask of our families. By joining our practice, families agree to these guidelines, which you can review here anytime or request in the office.

HIPAA Notice of Privacy Practices

Good Faith Estimate Notice

Privacy Policy

Terms of Use