Lifespan Physician Group Pediatric Primary Care Forms

The following forms are in PDF format unless otherwise noted.

ADHD Questionnaires

• Initial and Follow-up Questionnaires for Parents and Teachers (nichq.org)

Autism Screening

• M-CHAT-R (mchatscreen.com)

Miscellaneous Office Forms

• Nutrition Form for Well Visits
• Patient Information and Financial Responsibility Form
• Patient Portal Authorization Form
• Patient Satisfaction Survey
• Transfer of Medical Records

School Health Forms

• Rhode Island School Physical Form
• Massachusetts School Health Record
• Food Allergy & Anaphylaxis Emergency Care Plan (English | Spanish) (foodallergy.org)
• RI Asthma Action (English | Spanish)
• RI Diabetes Form