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Pediatric Consultants of Lenoir City

Forms

Parents and/or guardians are welcome to download, print, complete, and bring the appropriate forms to their appointment.

M-CHATTo be completed for Well Child visits from 18 months to age 3 (age 4 if not in preschool setting)Download
Pediatric Symptom ChecklistTo be completed at Well Child visits starting at age 5 (age 4 if already in a preschool setting) and for ADD/ADHD evaluations.Download

Vanderbilt Forms

Vanderbilt Assessment ScaleParent Informant - To be completed for ADD/ADHD evaluations.Download
Vanderbilt Assessment ScaleTeacher Informant - To be completed for ADD/ADHD evaluations.Download
Vanderbilt Assessment Follow-upParent Informant - To be completed for ADD/ADHD evaluations.Download
Vanderbilt Assessment Follow-upTeacher Informant - To be completed for ADD/ADHD evaluations.Download