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Mid Coast Medical Group
Mid Coast Medical Group MID COAST
Pediatrics
Forms

Please click on any of the areas below to display more information, including links to downloadable forms.

Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD)

When calling to schedule an initial appointment for ADD/ADHD, it is important to know that our providers will initially see your child for an extended (15-minute) visit. Your child must be present at this and all visits.

If your child is an established patient and you have a concern about ADD/ADHD, you may be asked to fill out a Vanderbilt Assessment form, and to have your child’s pediatric medical formsteachers also complete this form.

If you have been given forms to have completed, please be sure to bring the completed Vanderbilt forms to your child’s follow-up visit. The provider will score the forms and review them with you. These forms are extremely helpful in the diagnosis and treatment process.

Anxiety & Depression

If you or your child is concerned that he/she may have anxiety or depression, we recommend you contact our office to schedule an appointment to discuss your concerns with one of our providers. In advance of the appointment, you may print out the appropriate form below, have your child complete it, and bring it with you to the appointment. Alternatively, our provider may ask your child to fill one out when he/she comes in for his/her appointment. Please note that it is best to have the child complete the form. Parents may print another for themselves for completion.

Our providers generally see patients with depression or anxiety every six months.

Asthma & Allergy

Initial visits for asthma may be given a slightly longer appointment with the provider. Chronic medical conditions need to be monitored regularly. Our providers will want to see your child at least every six months to review medications and an asthma plan. Please try to call for prescription refills at least two weeks prior to running out.

Patients with asthma may need an Asthma Plan for home or school. You can avoid having to pick up a form at your child's school by printing one below and dropping it off at our office to be completed. Please be sure that you have filled out your child's name, date of birth, name of school, asthma medication(s) being used, and best Peak Flow number. If you have any questions about medications or Peak Flow, please speak with one of our nurses.

Autism Screening

The M-CHAT Screening questionnaire should be completed at the 18-month and 24-month Well Child Check appointments. To save time, we recommend that you print out the questionnaire below and complete it at home prior to coming to your child's appointment.

School/Camp/Sports Forms

Most schools and camps require that children have an updated annual physical (usually within the past year), proof of update-to-date immunizations, a list of any significant chronic conditions, and any medications. We are happy to complete our portion of these required forms. Please understand that our office receives a large volume of these forms. We do our very best to complete them in a timely fashion.

Before dropping off the form, please fill out as much of the form as you can. This will save time and help us to get your form completed more quickly and easily. If we have to contact you to obtain needed information for the form, it will potentially slow down the process considerably.

Ask the receptionist the date of your child's last Well Child Check. If it was more than one year ago, you will be required to schedule another. Let the receptionist know if your child has had any significant changes in his/her health in the past year (including any medication changes).

Tell the receptionist what you would like done with the form once it has been completed by us (i.e. fax, mail, or phone you to pick it up).

Please be aware that we require at least 48 hours to complete forms.

 

Mid Coast Pediatrics

 

Mid Coast Pediatrics welcomes all pediatric patients.

For more information or to make an appointment, please call (207) 721-8333.