Please find a list of our forms. Always make sure your Childs Name and Date of Birth are on all paperwork.  You can send us forms by:

 - Dropping them off at any of our clinics

 - Securely fill and sign them directly online using links below

 - Upload the fillable forms below to our secure portal at www.cardinalpediatrics.com/securesend

 - Email them directly to This email address is being protected from spambots. You need JavaScript enabled to view it., however, please keep in mind email is NOT a secure form of communication

 - Fax to 304-599-8003

 - Text a picture to 304-599-8000.   


Cardinal Forms

Securely Sign/Send Online Links Download Fillable Forms
New Patient Packet New Patient Packet
Release of Information to Cardinal Pediatrics Release of Information to Cardinal Pediatrics
Release of Information to Third Parties Release of Information to Third Parties
Patient Portal Signup through Follow My Health Patient Portal Signup through Follow My Health
* Patient portal signup form must be filled out prior to getting access to the patient portal. 

 

School Forms

Securely Sign/Send Online Links Download Fillable Forms
WV Sports Physical Form WV Sports Physical Form

 

Screeners

Securely Sign/Send Online Links Download Fillable Forms
ADHD FORMS
Vanderbilt - Initial Teacher Form Vanderbilt - Initial Teacher Form
Vanderbilt - Initial Parent Form Vanderbilt - Initial Parent Form
Vanderbilt - Followup Teacher Form Vanderbilt - Followup Teacher Form
Vanderbilt - Followup Parent Form Vanderbilt - Followup Parent Form
   
Child and Adolescent Trauma Screen (CATS)
CATS Patient / Self Report (7-17 years) CATS Patient / Self Report (7-17 years)
CATS Caregiver Report (3-6 years) CATS Caregiver Report (3-6 years)
CATS Caregiver Report (7-17 years) CATS Caregiver Report (7-17 years)
   
Colorado Learning Disabilities Screener
Colorado Learning Disabilities Screener Colorado Learning Disabilities Screener
     *Screen for children as early as 1st grade
Adult Reading History Questionnaire Adult Reading History Questionnaire
     *Both parents should fill out as over 50% of learning differences are hereditary
     *Screen while children are in Kindergarten
   
Patient Health Questionnaire (PHQ-9)
PHQ-9 Depression Screening PHQ-9 Depression Screening
   
Screen for Child Anxiety Related Disorders (SCARED)
SCARED Child Screener SCARED Child Screener
SCARED Parent Screener SCARED Parent Screener
   
Pediatric Symptom Checker PSC-17  
Pediatric Symptom Checker PSC-17   Pediatric Symptom Checker PSC-17
   
AUSTISM EVALUATION QUESTIONNAIRES  
Teacher/Caregiver Questionnaire Teacher/Caregiver Questionnaire
New Patient Intake (complete before Scheduling) New Patient Intake