Special Medical Forms

Consent to Treat for Your Child
Here is a sample form you may use to approve medical treatment for your child 
Consent to Treat for Your Child

Developmental Screening Forms
M-CHAT / MCHAT

Other Forms / Questionnaires:
ADD Evaluation Forms

Illinois State Standard School Form
This is the standard form for schools for Illinois.  Some day care facilities and camps also use this form.  Please download this form, complete the top of page one and the parent section on page two.  Submit all forms with a STAMPED ADDRESSED ENVELOPE as this will help expedite things, especially during the summer months when there is an extremely heavy volume. We also have the capability to print off a form for you from our computer - please send a STAMPED ADDRESSED ENVELOPE with your request.

Lead Screening Form
Need copy here

Pediatric Symptom Checklist
The PSC is a brief screening questionnaire that is used by pediatricians and other health professionals to improve the recognition and treatment of psychosocial problems in children.