Office Forms
All the office forms you need, in one place.
Save time by completing paperwork before your visit and make check-in quick and easy for you and your child.
Consent for 18-Year-Olds
Once your child turns 18, they’re officially considered an adult, which means their medical information becomes private under HIPAA laws. If they’d like to give you access to their health records or allow you to discuss their care with us, they’ll need to fill out and sign this consent form.
Medical Care Consent for Minors
By law, children under 18 can’t be seen by a doctor without a parent or legal guardian’s consent. If your child needs medical care and you can’t be there, this form lets you authorize another trusted adult (18 or older) to accompany them and make medical decisions on your behalf.
Stay Connected with Email
This form allows you to consent to email communication with Southwest Pediatrics, understanding the potential risks. Our preferred method of communication is always the AthenaHealth Patient Portal for secure messaging.
Medical Records Request & Release
If you need to request or transfer medical records, this form allows you to authorize the release of protected health information (PHI) to or from Austin Health Partners and Southwest Pediatric Associates.
Teen Depression Questionnaire
This screening tool helps teens and their healthcare providers assess feelings of sadness, anxiety, and overall well-being. It asks about mood, sleep, energy levels, concentration, and thoughts of self-harm. If your teen is struggling, this form can help start a conversation with their provider.
Parent Evaluation for Child’s Mental Health
This screening tool helps parents assess their child’s mood, behavior, and emotional well-being. Your responses provide valuable insight for your child’s healthcare provider to better understand their mental health and offer appropriate support.
Anxiety Survey
This screening tool helps assess anxiety symptoms in children from both the parent’s and the child’s perspective.
Both versions of the questionnaire provide valuable insight for your child’s healthcare provider to better understand their anxiety levels and offer appropriate support.
ADHD Parent Evaluation
This questionnaire helps parents assess ADHD symptoms and related behaviors in their child. It covers areas like attention span, hyperactivity, impulsivity, and emotional regulation. Your responses help your child’s healthcare provider better understand their challenges and determine the best support options.
ADHD Teacher Evaluation
This questionnaire helps teachers assess ADHD symptoms and learning behaviors in students. It evaluates focus, impulsivity, hyperactivity, organization, and emotional regulation. Teacher input is essential for a comprehensive understanding of a child’s challenges and strengths.
