Important Forms

There are many forms you may need for medical or dental checkups. You can access many of these through Health Passport or print and fill out any of the following forms for your appointments. If you do not have Acrobat Reader, please install it.

Health Passport Form Coversheet (PDF)

Behavioral Health Forms
Initial Behavioral Health Assessment (PDF)
Monthly Behavioral Health Review (PDF)

Dental Form
Dental Form (PDF)

Texas Health Steps Forms

Mental Health Interview Referral Forms
Ages 0-2 years (PDF)
Ages 3-9 years (PDF)
Ages 10-12 years (PDF)
Ages 13-20 years (PDF)
TB Questionnaire (PDF)

Other Forms
Non-Consent Emergency Care Notification (PDF)
DSHS Instructions for Child Health Clinical Record Forms (PDF)
Child Health History (PDF)
Hearing Checklist (PDF)
Lead Poisoning Questionnaire (PDF)
Notification of Pregnancy (PDF)
Electronic Visit Verification (EVV) Rights and Responsibilities (PDF)