Sprout forms

Patient information & consent (registered on portal)

Welcome & Sprout User Guide (registered on portal)

Expecting Parents Hospital and Clinic instructions

Health History (parent completes)

Newborn Health History

Health History (adolescent completes; coming soon)

Authorization for another provider to release information to Sprout Pediatrics: 

Authorization to release information from Sprout Pediatrics to another provider

Financial Policy

Acknowledgement of Receipt of Notice of Privacy Practices (Hipaa release)

 

Vaccine only registration

Circumcision only registration

Self-pay & non-covered services agreement


Helpful printables

Blank calendars for schedules, symptom calendars, behavior charts and family contests.

English

Spanish

Plain grid

Chart for keeping track of alternating or scheduled medication (please ask me before alternating tylenol and ibuprofen) to help avoid errors & over-dosing. 

Scheduled medicines or alternating chart (blank)

Alternating acetaminophen & ibuprofen chart

 

School & Activity forms

Sports Physical form (In Spanish)

Boy Scout Camp form

HIPAA/FERPA Release: Permission for school to share information with us.

Early Head Start (In Spanish)

ADHD Questionnaires (Vanderbilt forms)

 

Listen earnestly to anything your children want to tell you, no matter what. If you don’t listen eagerly to the little stuff when they are little, they won’t tell you the big stuff when they are big. Because to them all of it has always been big stuff.
— Catherine M Wallace