Health & Activity Forms

ACTIVITY FORMS (Fill out and bring with you to your child's appointment)

• Boy Scouts of America (BSA) Class 1 & 2 Personal Health and Medical Record Form (link directs to BSA website)
• Girl Scouts of Oregon & Southwest Washington Permission Slip & Health History Form (link directs to GS website)
• Oregon Sports Physical Form (Parents' Side Needs To Be Filled Out Before You Come For The Appointment)
• Pop Warner Physical Fitness and Medical History Form

 

CONCUSSION RELATED INFORMATION

• Concussion Information Page
• Pre-Concussion Assessment
• Post-Concussion Assessment for K - 6th graders
• Post-Concussion Assessment for 7th - 12th graders

 

SELF ASSESSMENT FORMS

• Abdominal Pain Diary
• Adolescent Depression Screening (PHQ-A)
• Asthma Control Test
• Headache Diary
• Pediatric Symptom Checklist (PSC)
• Postpartum Depression Scale (EPDS)
• Sleep Questionnaire (OSA-18)
• Teen Health Screen (CRAFFT S2BI)