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

 - Upload 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

• New Patient Packet
• Release of Information to Cardinal Pediatrics
• Release of Information to Third Parties
• Patient Portal Signup through Follow My Health - This must be filled out before getting access to the Patient Portal

School Forms

• WV Sports Physical Form 

Screeners

• ADHD Forms
  • Vanderbilt - Initial Teacher Form
  • Vanderbilt - Initial Parent Form
  • Vanderbilt - Followup Teacher Form
  • Vanderbilt - Followup Parent Form
• Child and Adolescent Trauma Screen (CATS)
  • CATS Patient / Self Report (7-17 years)
  • CATS Caregiver Report (3-6 years)
  • CATS Caregiver Report (7-17 years)

• Colorado Learning Disabilities Screener
  • Colorado Learning Disabilities Screener
    • Screen for children as early as 1st grade
  • 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
• Screen for Child Anxiety Related Disorders (SCARED)
  • SCARED Child Screen
  • SCARED Parent Screen