Forms - Central + Priority Pediatrics

Complete most of your forms online prior to your child being seen. If you’re a new patient, your first step is to complete the Family History Form and an age-specific Well Child Exam Form.

If COVID symptoms are present or you have had recent exposure to someone with COVID please reschedule your appointment.

General Clinic Forms

Well Child Exam Forms

Asthma Forms

Mental Health and ADHD Forms

Upload a form request or an immunization record request.

Bright Futures Handouts

To request a copy of your Immunization record, or the record of a person who you are the parent/guardian of, complete a Immunization Record Request.

Docket app and Immunization Records

View Patient Handouts and Resources:

:: Adolescents and School-aged Children: – Allergies in Children; – Asthma and Your Child; – Students With Chronic Health Conditions: Guidance for Families, Schools, and Students; More…

:: Bright Futures Education: -Well-Child Visit Handouts

:: Common Illnesses and Conditions: – Acute Ear Infections and Your Child; – Diarrhea and Your Child; – Fever and Your Child; –More…

:: Connected Kids (Violence Prevention): – Bullying: It’s Not OK; – How Do Infants Learn?; – Teaching Good Behavior: Tips on How to Discipline; – More…

:: Growth and Development: – Bedwetting; – Learning Disabilities: What Parents Need to Know; – Your Child’s Growth: Developmental Milestones; – More…

:: Immunization Information: – Immunizations: What You Need to Know; – Vaccine Information Statement: Your Childâ€™s First Vaccines; – Protect Yourself and Help Protect Your Baby: Information for New Moms on the Tdap Vaccine; – More…

:: Newborns, Infants, and Toddlers: – Diaper Rash and Your Baby; – Eczema (Atopic Dermatitis) and Your Child; – Jaundice and Your Newborn; – More…

:: Nutrition and Fitness: – Encourage Your Child to Be Physically Active; – Right from the Start: ABCs of Good Nutrition for Young Children; – Starting Solid Foods; – More…

:: Promoting Pediatric Care: – For Today’s Teens: A Message From Your Pediatrician; – Choosing a Pediatrician; – More…

:: Safety and Prevention: – Car Safety Seat Checkup; – Home Safety Checklist; – Parent’s Guide to Toy Safety; – More…

:: Schmitt Pediatric Care Advice: – Constipation (Baby); – Fever – How to Take the Temperature; – Toilet Training – How to Start; – More…

:: Sexual Health and Sexuality: – Deciding to Wait; – Puberty: Ready or Not Expect Some Big Changes; – Talking With Your Young Child About Sex; – More…

:: Substance Abuse Issues: – Drug Abuse Prevention Starts with Parents; – Substance Abuse Prevention; – Home Drug Testing: What Parents Need to Know; – More…

:: Teen Resources: – Acne: How to Treat and Control It; – Eating Disorders: Anorexia and Bulimia; – Headaches: What Teens Need to Know; – More…

:: TIPP Sheets: – Firearms Injury Prevention; – Home Water Hazards for Young Children; – 1 to 2 Years: Safety for Your Child; – More…

:: Vaccine Information Statements: – Vaccine Information Statement: Influenza (Flu) Vaccine (Inactivated or Recombinant); – Vaccine Information Statement: Pneumococcal Conjugate Vaccine (PCV13); – Vaccine Information Statement: MMR Vaccine (Measles, Mumps, and Rubella); – More…

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