Clinic Forms
New Patient Forms
- Patient Rights and Responsibilities
- Patient and Family Medical History Form
- Authorization to Treat in Absence
- Permission to Treat
- Authorization to Release Medical Information to Pediatric Associates of the NW
- Authorization to Release Medical Information from Pediatric Associates of the NW
- HIPAA Privacy Notice
- HIPAA Receipt
- Financial Policy
- Behavioral Health Authorization to Release/Disclose Confidential Information
Developmental Forms
- ASQ 9 Month Questionnaire (9 Month Well Child)
- M Chat (18 Month Well Child & 24 Month Well Child)
- ASQ 18 Month Questionnaire (18 Month Well Child)
- ASQ 24 Month Questionnaire (24 Month Well Child)
- ASQ 30 Month Questionnaire (30 Month Well Child)
Behavioral Health Forms
ADD/ADHD Evaluation Forms
Pain Reduction Handouts
Nutrition Forms
Frequently Used Forms
- Oregon Sports Physical Form
- Washington Sports Physical Form
- Boy Scouts Part A, B, and C
- Girl Scouts Health Form