{"id":1110,"date":"2020-12-24T11:28:03","date_gmt":"2020-12-24T11:28:03","guid":{"rendered":"https:\/\/www.toplinemd.com\/wellington-pediatrics\/?page_id=1110"},"modified":"2023-03-16T14:37:41","modified_gmt":"2023-03-16T14:37:41","slug":"patient-forms","status":"publish","type":"page","link":"https:\/\/www.toplinemd.com\/wellington-pediatrics\/patient-forms\/","title":{"rendered":"Patient Forms"},"content":{"rendered":"<p><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-parallax-none nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-background-position:center bottom;--awb-background-blend-mode:overlay;--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:6%;--awb-padding-bottom:6%;--awb-background-color:rgba(255,255,255,0.35);--awb-background-image:url(&quot;https:\/\/www.toplinemd.com\/wellington-pediatrics\/wp-content\/uploads\/sites\/118\/2020\/12\/Patient-Forms-Header-background-2.png&quot;);--awb-background-size:cover;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_5 1_5 fusion-one-fifth fusion-column-first\" style=\"--awb-bg-size:cover;width:20%;width:calc(20% - ( ( 4% + 4% ) * 0.2 ) );margin-right: 4%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-clearfix\"><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_3_5 3_5 fusion-three-fifth fusion-animated\" style=\"--awb-padding-top:1px;--awb-bg-color:rgba(120,50,136,0.63);--awb-bg-color-hover:rgba(120,50,136,0.63);--awb-bg-size:cover;width:60%;width:calc(60% - ( ( 4% + 4% ) * 0.6 ) );margin-right: 4%;\" data-animationType=\"fadeInDown\" data-animationDuration=\"0.6\" data-animationOffset=\"top-into-view\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-title title fusion-title-1 fusion-sep-none fusion-title-center fusion-title-text fusion-title-size-one\" style=\"--awb-text-color:#ffffff;--awb-margin-top:30px;--awb-margin-bottom:30px;--awb-margin-top-small:20px;--awb-margin-right-small:0px;--awb-margin-bottom-small:20px;--awb-margin-left-small:0px;\"><h1 class=\"fusion-title-heading title-heading-center fusion-responsive-typography-calculated\" style=\"margin:0;--fontSize:63;line-height:1.1;\"><strong>Patient Forms<\/strong><\/h1><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_5 1_5 fusion-one-fifth fusion-column-last\" style=\"--awb-bg-size:cover;width:20%;width:calc(20% - ( ( 4% + 4% ) * 0.2 ) );\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-clearfix\"><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-3 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last fusion-animated\" style=\"--awb-padding-top:1px;--awb-bg-size:cover;\" data-animationType=\"fadeInDown\" data-animationDuration=\"0.6\" data-animationOffset=\"top-into-view\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-image-element fusion-image-align-center in-legacy-container\" style=\"text-align:center;--awb-caption-title-font-family:var(--h2_typography-font-family);--awb-caption-title-font-weight:var(--h2_typography-font-weight);--awb-caption-title-font-style:var(--h2_typography-font-style);--awb-caption-title-size:var(--h2_typography-font-size);--awb-caption-title-transform:var(--h2_typography-text-transform);--awb-caption-title-line-height:var(--h2_typography-line-height);--awb-caption-title-letter-spacing:var(--h2_typography-letter-spacing);\"><div class=\"imageframe-align-center\"><span class=\" fusion-imageframe imageframe-none imageframe-1 hover-type-none\"><img decoding=\"async\" width=\"92\" height=\"101\" title=\"logic\" src=\"https:\/\/www.toplinemd.com\/wellington-pediatrics\/wp-content\/uploads\/sites\/118\/2020\/12\/logic.png\" alt class=\"img-responsive wp-image-1167\"\/><\/span><\/div><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-2 nonhundred-percent-fullwidth non-hundred-percent-height-scrolling padding-wrapper\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:7%;--awb-padding-bottom:6%;--awb-margin-bottom:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-4 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last fusion-animated\" style=\"--awb-bg-size:cover;--awb-margin-bottom:0px;\" data-animationType=\"slideInLeft\" data-animationDuration=\"0.6\" data-animationOffset=\"top-into-view\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-text fusion-text-1\"><h2>Downloadable Forms:<\/h2>\n<\/div><ul style=\"--awb-size:18px;--awb-line-height:30.6px;--awb-icon-width:30.6px;--awb-icon-height:30.6px;--awb-icon-margin:12.6px;--awb-content-margin:43.2px;--awb-circlecolor:#783288;--awb-circle-yes-font-size:15.84px;\" class=\"fusion-checklist fusion-checklist-1 fusion-checklist-default type-icons\"><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-yes\"><i class=\"fusion-li-icon fa-file-pdf fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\"><a href=\"\/wellington-pediatrics\/wp-content\/uploads\/sites\/118\/2022\/03\/NEW-PATIENT-FORMS-2022.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">New Patient Registration<\/a><\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-yes\"><i class=\"fusion-li-icon fa-file-pdf fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"\/wellington-pediatrics\/wp-content\/uploads\/sites\/118\/2020\/12\/PatientHealthQuestionnaireforTeens.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Behavioral Health Questionnaire for Teens<\/a><\/p>\n<\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-yes\"><i class=\"fusion-li-icon fa-file-pdf fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"\/wellington-pediatrics\/wp-content\/uploads\/sites\/118\/2020\/12\/BehavioralHealthScreeningConsent.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Behavioral Health Screening Consent<\/a><\/p>\n<\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-yes\"><i class=\"fusion-li-icon fa-file-pdf fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"\/wellington-pediatrics\/wp-content\/uploads\/sites\/118\/2020\/12\/NICHQVanderbiltAssessment-FULL-1.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">ADD\/ADHD Vanderbilt Scales<\/a><\/p>\n<\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-yes\"><i class=\"fusion-li-icon fa-file-pdf fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"\/wellington-pediatrics\/wp-content\/uploads\/sites\/118\/2020\/12\/ADHD-NEW-PAT-PACKET.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">ADD\/ADHD New Patient Packet &amp; Forms<\/a><\/p>\n<\/div><\/li><li class=\"fusion-li-item\" style=\"\"><span class=\"icon-wrapper circle-yes\"><i class=\"fusion-li-icon fa-file-pdf fas\" aria-hidden=\"true\"><\/i><\/span><div class=\"fusion-li-item-content\">\n<p><a href=\"\/wellington-pediatrics\/wp-content\/uploads\/sites\/118\/2020\/12\/Telehealth-Consent.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Telehealth Consent<\/a><\/p>\n<\/div><\/li><\/ul><div class=\"fusion-clearfix\"><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-3 hundred-percent-fullwidth non-hundred-percent-height-scrolling fusion-equal-height-columns wh2footerlogos\" style=\"--awb-border-sizes-top:0px;--awb-border-sizes-bottom:0px;--awb-border-sizes-left:0px;--awb-border-sizes-right:0px;--awb-border-color:#783288;--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:0px;--awb-padding-right:0px;--awb-padding-left:0px;--awb-background-color:#f0f3f6;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-5 fusion_builder_column_1_2 1_2 fusion-one-half fusion-column-first wh2footerlogo\" style=\"--awb-padding-top:40px;--awb-padding-left:12%;--awb-bg-size:cover;width:50%;width:calc(50% - ( ( 4% ) * 0.5 ) );margin-right: 4%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-column-content-centered\"><div class=\"fusion-column-content\"><div class=\"fusion-image-element in-legacy-container\" style=\"--awb-caption-title-font-family:var(--h2_typography-font-family);--awb-caption-title-font-weight:var(--h2_typography-font-weight);--awb-caption-title-font-style:var(--h2_typography-font-style);--awb-caption-title-size:var(--h2_typography-font-size);--awb-caption-title-transform:var(--h2_typography-text-transform);--awb-caption-title-line-height:var(--h2_typography-line-height);--awb-caption-title-letter-spacing:var(--h2_typography-letter-spacing);\"><span class=\" fusion-imageframe imageframe-none imageframe-2 hover-type-none\"><a class=\"fusion-no-lightbox\" href=\"\/wellington-pediatrics\/\" target=\"_self\" aria-label=\"well\"><img decoding=\"async\" width=\"270\" height=\"150\" src=\"https:\/\/www.toplinemd.com\/wellington-pediatrics\/wp-content\/uploads\/sites\/118\/2022\/12\/well.png\" alt class=\"img-responsive wp-image-1255\" srcset=\"https:\/\/www.toplinemd.com\/wellington-pediatrics\/wp-content\/uploads\/sites\/118\/2022\/12\/well-200x111.png 200w, https:\/\/www.toplinemd.com\/wellington-pediatrics\/wp-content\/uploads\/sites\/118\/2022\/12\/well.png 270w\" sizes=\"(max-width: 1000px) 100vw, 270px\" \/><\/a><\/span><\/div><\/div><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-6 fusion_builder_column_1_2 1_2 fusion-one-half fusion-column-last wh2footerlogo\" style=\"--awb-padding-top:40px;--awb-padding-right:4%;--awb-bg-size:cover;width:50%;width:calc(50% - ( ( 4% ) * 0.5 ) );\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-column-content-centered\"><div class=\"fusion-column-content\"><div class=\"fusion-image-element fusion-image-align-left in-legacy-container\" style=\"text-align:left;--awb-max-width:300px;--awb-caption-title-font-family:var(--h2_typography-font-family);--awb-caption-title-font-weight:var(--h2_typography-font-weight);--awb-caption-title-font-style:var(--h2_typography-font-style);--awb-caption-title-size:var(--h2_typography-font-size);--awb-caption-title-transform:var(--h2_typography-text-transform);--awb-caption-title-line-height:var(--h2_typography-line-height);--awb-caption-title-letter-spacing:var(--h2_typography-letter-spacing);\"><span class=\" fusion-imageframe imageframe-none imageframe-3 hover-type-none\" style=\"margin-right:25px;float:left;\"><a class=\"fusion-no-lightbox\" href=\"https:\/\/www.toplinemd.com\/why-topline-md\/\" target=\"_blank\" aria-label=\"TopLine MD-RegisterR_Stacked_Logo_rgb_color\" rel=\"noopener noreferrer\"><img decoding=\"async\" width=\"1576\" height=\"376\" src=\"https:\/\/www.toplinemd.com\/wellington-pediatrics\/wp-content\/uploads\/sites\/118\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color.png\" alt class=\"img-responsive wp-image-2528\" srcset=\"https:\/\/www.toplinemd.com\/wellington-pediatrics\/wp-content\/uploads\/sites\/118\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color-200x48.png 200w, https:\/\/www.toplinemd.com\/wellington-pediatrics\/wp-content\/uploads\/sites\/118\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color-400x95.png 400w, https:\/\/www.toplinemd.com\/wellington-pediatrics\/wp-content\/uploads\/sites\/118\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color-600x143.png 600w, https:\/\/www.toplinemd.com\/wellington-pediatrics\/wp-content\/uploads\/sites\/118\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color-800x191.png 800w, https:\/\/www.toplinemd.com\/wellington-pediatrics\/wp-content\/uploads\/sites\/118\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color-1200x286.png 1200w, https:\/\/www.toplinemd.com\/wellington-pediatrics\/wp-content\/uploads\/sites\/118\/2026\/03\/TopLine-MD-RegisterR_Stacked_Logo_rgb_color.png 1576w\" sizes=\"(max-width: 1000px) 100vw, 600px\" \/><\/a><\/span><\/div><\/div><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":13,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-1110","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.toplinemd.com\/wellington-pediatrics\/wp-json\/wp\/v2\/pages\/1110","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.toplinemd.com\/wellington-pediatrics\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.toplinemd.com\/wellington-pediatrics\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.toplinemd.com\/wellington-pediatrics\/wp-json\/wp\/v2\/users\/13"}],"replies":[{"embeddable":true,"href":"https:\/\/www.toplinemd.com\/wellington-pediatrics\/wp-json\/wp\/v2\/comments?post=1110"}],"version-history":[{"count":0,"href":"https:\/\/www.toplinemd.com\/wellington-pediatrics\/wp-json\/wp\/v2\/pages\/1110\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.toplinemd.com\/wellington-pediatrics\/wp-json\/wp\/v2\/media?parent=1110"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}