Patient Forms

New Patient Forms

If your child is a new patient, you will be asked to complete the following form.

• New patient medical history form (PDF)

Well-child visit forms

At some of your child’s regular check-ups, you will be asked to fill out a questionnaire about your child’s health. You can complete these forms in advance by downloading the appropriate questionnaire, filling it out and bringing the completed form to your child’s appointment. Please note that not all recommended check-ups will have forms.

• Well-child check: 2 week visit
• Well-child check: 1 month visit
• Well-child check: 2 month visit
• Well-child check: 4 month visit
• Well-child check: 6 month visit
• Well-child check: 9 month visit
• Well-child check: 12 month visit
• Well-child check: 15 month visit
• Well-child check: 18 month visit
  • 18 month visit MCHAT
• Well-child check: 2 year visit
  • 2 year visit MCHAT
• Well-child check: 2 1/2 year visit
• Well-child check: 3 year visit
• Well-child check: 4 year visit
• Well-child check: 5 year visit
• Well-child check: 6 year visit
• Well-child check: 7 year visit
• Well-child check: 8 year visit
• Well-child check: 9-11 year visit
• Well-child check: 12-17 year visit
• Well-child check: 18+ year visit

Administrative forms

• Authorization to consent to medical treatment of a minor
• Authorization for release of health information in English
• Authorization for release of health information in Spanish

For more information, visit medicalrecords.stanfordchildrens.org.