Four Seasons Pediatrics

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Forms

To save time at your visit, we strongly encourage all patients to print and bring their filled out forms to the appointment.

You mail email (by scanning or taking a photo with your phone) any forms to: Exchange@fourseasonspediatrics.com. You may fax the form to us at 518-383-3255 if that works best.

Please note that all forms that require a signature must be hand signed, we will not accept a typed or digital signature.

Flu Vaccine Screening FormClick Here-Please complete prior to arrival

Registration Forms (this includes most of the items below, so you can print the entire set at one time)

Well Visit Forms click link below:

  • Please note that we are transitioning to the use of forms through CHADIS. Click here to We prefer you use these forms as they are very complete and improve care. Log into your web portal through a browser (not the Healow App). On the homepage, look for the Milestones Tile. If you are within 2 weeks of your well visit, you will see a button under Milestones called CHADIS. Click this button and it will show all questionnaires we want you to fill out. Please try to do at least one day before your appointment. Thank you.
  • Well Physical Exam Forms – Only use these now if you do not have a web portal account

ADHD Forms click below:

  • Please note that we are transitioning to the use of forms through CHADIS. We prefer you use these forms as they are very complete and improve care. If you have not used it yet, please call our office. Ask our staff to create an account with an invitation code. Once your account is set up, staff will assign questionnaires for you to fill out. These are forms that use the newer DSM 5 criteria. Once set up, you can log in directly or log into your web portal account. Open a browser (not the Healow App). On the homepage, look for the Milestones Tile. If you are within 2 weeks of your ADHD visit OR you can request staff to assign ADHD questionnaires to schedule an appointment. When you login to your portal account, you will see a button under Milestones called CHADIS. Click this button and it will show all questionnaires we want you to fill out. Please try to do at least one day before your appointment. Thank you.
  • Once you have logged into CHADIS, click here to learn how to INVITE A TEACHER. It only has to be done once.
  • Once you have logged into CHADIS, click here to learn how to INVITE YOUR TEEN to answer questionnaires. It only has to be done once
  • ADHD Forms (Initial evaluation click here. For follow up visits, we now prefer CHADIS rather then the forms above – in either case, please note that we require return of these forms BEFORE we will schedule your appointment)

Consent and Record Release forms: You mail email (by scanning or taking a photo with your phone) any forms to: Exchange@fourseasonspediatrics.com or fax to the number listed above.

Updated information:

Other Forms:

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