Forms | Camelback Pediatrics

For the most up-to-date information on our accepted private health insurance plans

contact our clinic directly at 602-840-3120

Forms

Save time by downloading these forms at home.

Patient Registration Packet

Telephone/Telemedicine Consent Form (NOTE: To sign digitally, you must open the document in a PDF application, complete, sign and email back to us. Optionally, you can print, complete, scan and return via email.)

Record Release Form

Consent to Release Information form (for patient's 18 or older)

Patient Behavioral Health Surveys

MChat

Vanderbilt Parent's

Vanderbilt Teacher's

PHQ-9 Modified for Teens

PHQ-9 Adult

SCARED Anxiety Screen - child to complete

SCARED Anxiety Screen - parents to complete

GAD-7 Anxiety Screen

Attention Deficit Disorder Initial Intake Questionaire