Patient Forms

These forms are provided for your convenience and can be completed on-line and submitted to our office prior to your first appointment. For new patient enrollment, we require the New Patient Registration Packet and the Initial Health History Questionnaire to be completed. As a reminder, our office only accepts new patients who are up-to-date on their immunizations and remain on the standard schedule.

   

New Patient Forms

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For new patients to our office, please complete both the HIPAA Compliant fillable New Patient Registration and Initial Health History questionnaire and submit them to the office prior to your first appointment. 

New Patient Registration Packet

Initial Health History Questionnaire 

Print Version: New Patient Registration Packet with Initial Health History

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Please review the following policies: 

HIPAA Privacy Policy

Patient Bill of Rights

Form Icon   Co-Parenting Policy
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Established Patient Update Sheet


Adult Patient Registration Packets (on-line fillable form)

Adult Patient Registration Packets (pdf to print and complete)

   

High School Sports Forms

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Kansas State High School Activity Association Participation Form

Pre-Season COVID Screening Form

   

ADHD / ADD Assessments

 Form Icon    ADHD/ADD Vanderbilt Assessment Form (Parent)
 Form Icon   ADHD/ADD Vanderbilt Assessment Form (Teacher) 
Form Icon    Controlled Substance Agreement
   

Transferring Records Consents 

Form Icon   Transferring to Our Office
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Transferring from Our Office (complete and submit on-line)

Transferring from Our Office (pdf version for printing)

     
   

Mental Health Questionnaires

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SCARED Parent

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SCARED Youth

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PHQ-9 Questionnaire


Psychiatric Medication Agreement

Lawrence Pediatrics, PA
3310 Clinton Parkway Ct
Lawrence, KS 66047

Phone: 785.856.9090
Fax: 785.856.9093

Our Hours
Monday thru Friday:
8am to 5pm
*Closed from 12:00-1:20
*Phone answered until 4:00 p.m. messages left after that will be returned the next business day

After Hours Information

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