Patient Forms
Below you will find a complete list of our patient forms. In an effort to provide the best care possible and minimize your wait time in our office, please complete these forms ahead of time. You can always contact our front desk at (561) 654-2828 if you’d like a link to fill these out online.
Submitting Patient Forms: What You Need to Know
You can submit your forms through our patient portal online or print them out and bring them with you to your appointment. To view and print these forms, you’ll need to download the Adobe reader here.
Please note that we take the privacy and security of our patients information very seriously. We are unable to accept any form that contains protected health information (PHI) via email. This includes any form that contains 2 or more pieces of identifying information (name, address, date of birth, telephone number, etc.)
New Patients
In order to speed up the process of checking in your child for his/her first visit with us, it will be helpful, and minimize your wait time, if you would complete these forms ahead of your visit.
Well Visits
Well Visit (2 weeks - 6 months)
Maternal postpartum depression screening for mothers with children 2 weeks to 6 months of age. Please complete this form ahead of your appointment.
Well Visit (18 months & 2 years)
The M-CHAT is a screening test for Autism that we perform at these two visits. Please complete this form ahead of your appointment.
Well Visit (4 years - 11 years)
We are screening for behavior issues with the Pediatrics Symptom Checklist for all children ages 4 years – 11 years of age. Please complete this form ahead your appointment. This screening will be discussed with you by your provider. This form is to be filled out by the parent.
Well Visit (11 years and beyond)
We are screening for depression with the PHQ-9 for all teens from ages 12 and up. Please have your child complete this form ahead of your appointment. This screening will be discussed with you by your provider.
Patient Health Questionnaire (PHQ-9)
This form helps us understand any social or environmental challenges that might be affecting your family’s health—like housing, food, transportation, or safety - so that we can better support your needs.
Sports Physicals
The different counties served by Bluebird Kids Health each have their own specific form for school sports physicals. As these forms change annually, we have provided you a direct link to these respective forms. Please choose the county school district your child is enrolled in, print the form, and bring it with you to your appointment. Unfortunately, we are not aware of the Martin County school district having any sports physical forms online at this time.
Palm Beach School District
On the Palm Beach County School District website, scroll down the page and select the level of schooling that applies to your child and choose the applicable forms.
St. Lucie School District
On the St. Lucie County School District website, scroll down the page, almost to the bottom, and find the section in the center column entitled, ATHLETIC RESOURCES. Select the respective packet of forms dependent on the age of your child.
Duval School District
The Duval school district uses this form. Please print it out and bring it to your appointment if needed.
New Patients
In order to speed up the process of checking in your child for his/her first visit with us, it will be helpful, and minimize your wait time, if you would complete these forms ahead of your visit.
Well Visits
Well Visit (2 weeks - 6 months)
Maternal postpartum depression screening for mothers with children 2 weeks to 6 months of age. Please complete this form ahead of your appointment.
Well Visit (18 months & 2 years)
The M-CHAT is a screening test for Autism that we perform at these two visits. Please complete this form ahead of your appointment.
Well Visit (4 years - 11 years)
We are screening for behavior issues with the Pediatrics Symptom Checklist for all children ages 4 years – 11 years of age. Please complete this form ahead your appointment. This screening will be discussed with you by your provider. This form is to be filled out by the parent.
Lista de Síntomas Pediátricos / Pediatric Symptom Checklist (PSC-17)
Well Visit (11 years and beyond)
We are screening for depression with the PHQ-9 for all teens from ages 12 and up. Please have your child complete this form ahead of your appointment. This screening will be discussed with you by your provider.
Una Encuesta de Parte de su Proveedor de Cuidados de Salud (PHQ-9)
Herramienta de evaluación de necesidades sociales (AAFP)
This form helps us understand any social or environmental challenges that might be affecting your family’s health—like housing, food, transportation, or safety - so that we can better support your needs.
Sports Physicals
The different counties served by Bluebird Kids Health each have their own specific form for school sports physicals. As these forms change annually, we have provided you a direct link to these respective forms. Please choose the county school district your child is enrolled in, print the form, and bring it with you to your appointment. Unfortunately, we are not aware of the Martin County school district having any sports physical forms online at this time.
Palm Beach School District
On the Palm Beach County School District website, scroll down the page and select the level of schooling that applies to your child and choose the applicable forms.
St. Lucie School District
On the St. Lucie County School District website, scroll down the page, almost to the bottom, and find the section in the center column entitled, ATHLETIC RESOURCES. Select the respective packet of forms dependent on the age of your child.
Duval School District
The Duval school district uses this form. Please print it out and bring it to your appointment if needed.
New Patients
In order to speed up the process of checking in your child for his/her first visit with us, it will be helpful, and minimize your wait time, if you would complete these forms ahead of your visit.
Well Visits
Well Visit (2 weeks - 6 months)
Maternal postpartum depression screening for mothers with children 2 weeks to 6 months of age. Please complete this form ahead of your appointment.
Well Visit (18 months & 2 years)
The M-CHAT is a screening test for Autism that we perform at these two visits. Please complete this form ahead of your appointment.
Lis Kontwòl yo Modifye pou tcheke Otis kay Timoun Piti, Korije avèk Suivi (M-CHAT-R/F)
Well Visit (4 years - 11 years)
We are screening for behavior issues with the Pediatrics Symptom Checklist for all children ages 4 years – 11 years of age. Please complete this form ahead your appointment. This screening will be discussed with you by your provider. This form is to be filled out by the parent.
Well Visit (11 years and beyond)
We are screening for depression with the PHQ-9 for all teens from ages 12 and up. Please have your child complete this form ahead of your appointment. This screening will be discussed with you by your provider.
Kesyonè sou Sante Pasyan-9 (PHQ-9)
This form helps us understand any social or environmental challenges that might be affecting your family’s health—like housing, food, transportation, or safety - so that we can better support your needs.
Sports Physicals
The different counties served by Bluebird Kids Health each have their own specific form for school sports physicals. As these forms change annually, we have provided you a direct link to these respective forms. Please choose the county school district your child is enrolled in, print the form, and bring it with you to your appointment. Unfortunately, we are not aware of the Martin County school district having any sports physical forms online at this time.
Palm Beach School District
On the Palm Beach County School District website, scroll down the page and select the level of schooling that applies to your child and choose the applicable forms.
St. Lucie School District
On the St. Lucie County School District website, scroll down the page, almost to the bottom, and find the section in the center column entitled, ATHLETIC RESOURCES. Select the respective packet of forms dependent on the age of your child.
Duval School District
The Duval school district uses this form. Please print it out and bring it to your appointment if needed.