Patient Forms

Our patient forms are here for you should you ever need them. You will have the ability to complete registration and required forms electronically through Phreesia during appointment check-in, as well.

General Forms

Medical Information Forms

HIPAA Forms

Developmental Screening Forms

Well Visit Anticipatory Guidance Sheets

Clinical Information Handouts

Depression & Anxiety Forms

ADHD Forms and Questionnaires

Weight Management

Letter/ Forms Completion

We will gladly fill out required forms for your child at his or her well checkup at no charge. However, if you need any forms or letters completed outside of your scheduled well-child appointment, there will be a fee per child. The Carithers Pediatric Group reserves the right to modify these charges from time to time at our discretion. If a type of form presented for completion is not included in this list, we reserve the right to apply a fee that we deem appropriate.

An additional fee of $5.00 will be charged if the forms are sent to us by email to complete or if the office has to email, mail or fax the forms to the parent. If forms are picked up and dropped off, no additional fee will be charged.

FMLA/ Disability Forms: $30.00
Typed Letters: $20.00
Shot Records: $10.00
College Forms: $10.00
Camp Forms: $10.00
Physical Forms: $10.00
Sports Forms: $10.00
Overseas/ Travel Forms: $10.00
Notarized Forms: $15.00