Downloadable Medical Forms

Patient Forms

• Patient Registration and Disclosure Form
• Financial Policy
• Behavioral Health New Patient Packet
• Provider Transfer Request
• Prepare for your New Patient Appointment

HIPAA Forms

• Notice of privacy practices

Release of Information Forms

• Medical Records Release Form
• Important Information about Release of Information
• Authorization to Discuss Health Information

• • Consent for Medical Care and Services to a Minor Child
  • Pediatric New Patient Packet
  • Newborn Packet
  • OSAA Sports Physical Form
  • Covid 19 Screening and Consent Form
  • BMC Child Centered Summary
  • BMC Visual Schedule
  • Social Story: A Doctor Visit with BMC

New Born Birth Certificate Requests

• Telehealth Forms
  • GAD7
  • PHQ-9

Developmental Questionnaires

Ages & Stages Questionnaires (ASQ-3)

• 9 Month Well Visit
• 18 Month Well Visit
• 2 Year Well Visit
• 4 Year Well Visit

Screening Tools

• Modified Checklist for Autism in Toddlers at 18 and 24 months (M-CHAT)
• Edinburgh Postnatal Depression Scale (EPDS)

Concussion Forms

• Acute Concussion Evaluation
• Sports Concussion Assessment Tool (SCAT5) – Ages 5-12 
• Sports Concussion Assessment Tool (SCAT5) – Ages 13-up