Patient Information

Knowing what to expect at your appointments and having an opportunity to fill out necessary forms prior to arrival provides an opportunity to get the most out of your upcoming visit.

New patients

Please arrive 20 minutes early and remember to bring the following:

• Insurance Card
• Immunization Records
• Patient Information Form (DOC)
• Past Medical History Form (DOC)

Current patients

Please bring the following:

• Insurance Card

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Administrative Forms

• Patient Communication Form (PDF)
• Telehealth Consent to Treatment: PDF; Microsoft Word
• Medical Records Requests: You may obtain a copy of your medical record created by and/or maintained by your Washington University Physicians provider by clicking here.

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Well Visit Forms

Certain questionnaires are important to your child’s pediatric care at specific visits. Please fill out the following forms for your upcoming visit if your child fits into one of these categories:

• 1 Month Well Visit (PDF)
• 2 Month Well Visit (PDF)
• 9 Month Well Visit (PDF)
• 18 Month Well Visit
  • M-CHAT (PDF)
  • 18 Month Questionnaire (PDF)
• 2 Year Well Visit (PDF)
• 2.5 Year Well Visit (PDF)
• 4 – 10 Year Well Visit (PDF)
• 11 – 13 Year Well Visit (PDF)
• 14 – 21 Year Well Visit
  • Patient Health Questionnaire (PDF)
  • CRAFFT Questionnaire (PDF)

Other Visit Types

• Initial ADHD Visit (PDF)
• Follow-up ADHD Visit (PDF)
• Initial Anxiety / Depression Visit
  • Initial Anxiety / Depression Visit – Parent Form (PDF)
  • Initial Anxiety / Depression Visit – Child Form (PDF)
  • Patient Health Questionnaire (PDF)
  • CRAFFT Questionnaire (PDF)
• Follow-up Anxiety / Depression Visit
  • Patient Health Questionnaire (PDF)
  • GAD-7 (PDF)