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

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.

Daycare/ School forms, WIC Forms: $5.00
College forms, Sports/Camp forms, and Overseas/Travel forms: $10.00
FMLA/ Disability forms: $20.00
Family Empowerment Scholarship (or other Scholarship) letter: $20.00