|PEDIATRIC NEW PATIENTS (ages 3 months to 12 years)
Please print/download each questionnaire and complete prior to your first visit.
1. Pediatric Questionnaire. Parents should complete this 4 page questionnaire with the help of the child (if the child is old enough) prior to the first visit. It is important to answer every question as honestly and accurately as you can. When evaluating a child with sleep problems we need to be as thorough as possible.
Click Here to
Print Out Form
2. History Form & Patient Information Form. This is our standard medical history form that is completed by all patients in our practice. Please provide as much detailed information as possible. It might be helpful to have your childs prescriptions handy when completing the Current Medications section. The parent or guardian should bring insurance card(s) to the childs first visit. Click here to find out about insurance coverage. If the parent or guardian has a cell phone number and email address, please include those on the form. Many people find it more convenient to be contacted by cell phone or email.
Click Here to Print Out Form