Patient Forms

New Patient Forms

New Patient Registration Packet: Please complete these forms and bring them to your child’s first appointment

Release of Information Request to LaTouche Pediatrics: Please complete this form and submit it to your child’s previous provider(s) in order for us to receive your child’s medical records

Prenatal Form

Prenatal History Form: Please complete this form and bring to your prenatal appointment

Existing Patient Forms

Consent and Authorization for Treatment of a Minor: Please complete this form if you would like to authorize other adults to bring your child to appointments, make requests, or pick up prescriptions

Release of Information Request- From LaTouche Pediatrics: Please complete this form if you would like a copy of your child’s medical records or if you need their records sent to another provider

ADD/ADHD

ADD/ADHD Parent Questionnaire: Please complete this form and bring it your child’s ADD/ADHD appointment

Vanderbilt Parent Form: Please complete this form and bring to your child’s ADD/ADHD appointment

Vanderbilt Teacher Form: Please have your child’s teacher complete this form for you to bring to your child’s ADD/ADHD appointment

Over 18

Consent and Authorization for Patient Over 18: Please complete this form if you are a patient, 18 years old or older, and would like to authorize your parent(s) to make requests, pick up prescriptions, have patient portal access, or have access to your medical records