Patient Forms

Access PM Kidz pediatric patient forms online to save time at your visit. Complete and return your child’s paperwork before your appointment to ensure a fast, easy check-in experience at our Southern Maryland clinic.

Request AppointmentBrowse Services

Completing the necessary paperwork before your child’s visit helps expedite the check-in process. Please take a moment to fill out all applicable areas on the form before returning it to our office.

Schools & Sports

Maryland Health Inventory – School Physical
Sports Physical
Medication Administration Authorization
Immunization Certificate
Blood Lead Testing Certificate
Diet Modification Form for Special Dietary Needs

Developmental Assessment: Age & Stages Questionnaires

9 months | 12 months | 15 months | 18 months | 24 months | 30 months | 36 months

ADHD

Vanderbilt Parent Initial
Vanderbilt Teacher Initial

ADHD Follow-Up

Complete after treatment has started.

Vanderbilt Parent Follow-up
Vanderbilt Teacher Follow-up

Anxiety

SCARED (ages 11+ years and older)
SCARED (parent)

Autism

M-CHATR/F (18 months & 24 months)

Behavior/Emotional Assessment

Pediatric Symptom Checklist for Children (ages 4-10)
Pediatric Symptom Checklist for Youth (ages 11 years and older)

Depression

• PHQ-9 for Teens
• Edinburgh Postnatal Depression Scale (for moms with infants from birth to 12 months)