Forms

General Forms

Click on an item below to download a fillable pdf form.

1. Over 18 HIPAA Release Consent Form
2. Patient Health Questionnaire
3. M-Chat
4. Family Registration Form
5. Financial Policy
6. Acknowledgement of Receipt of Notice of Privacy Practices
7. Consent to Treat

Or, you can download all 7 general forms in a zip file by clicking here.

Policies

• Addition of Surprise Billing Notice – Federal
• Good Faith Estimate – In accordance with law, Guardian Pediatrics follows the guidelines set by House Bill 1447. If you would like to read House Bill 1447, please visit the Indiana General Assembly website. Or, you can click the following link to download our Good Faith Estimate.
• Medication Refill Policy
  

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IHSAA

Click the following link to download the pre-participation physical evaluation form (PPE) – download form.

NICHQ

NICHQ, National Institute for Children’s Health Quality, offers an assessment scale used in diagnosing ADHD. Click the following link to download the form – NICHQ Vanderbilt Assessment Scales

Vaccine Information

This download includes everything you need to know about your child’s first vaccines. To download the vaccine information, please click the following link. Download Your Child’s First Vaccine Information