Forms

All new patients must first call our New Patient Representative prior to making an initial appointment. Please call (970) 267-6717 to establish your child as a patient at The Youth Clinic.

To expedite your visit, you can download our commonly used forms below:

Forms to bring to ADHD appointment: 

Initial Parent Evaluation
Initial Teacher Evaluation
Follow Up Parent Evaluation
Follow Up Teacher Evaluation

School/Camp/Daycare Forms Policies:

  1. Blank forms will not be accepted. Please complete form in its entirety (patient info, names of medications and doses, etc.). Blank forms will be returned unsigned.
  2. Due to HIPAA and best privacy and security practices, we will return forms via mail of placing for pickup at one of our 4 office locations. Faxing and emailing are not secure methods of transferring personal health information.
  3. Turn around time will be 7 business days FREE of charge. While every effort is made to complete forms as quickly as possible, parents should realize that at certain times of year we may receive hundreds of health forms per week and each one must be carefully reviewed. Parents are strongly advised not to wait until the last moment to turn in paperwork.
  4. If you are unable to wait 7 business days for completion, you may stop in to one of our office locations where a $30 fee will be collected and a rush form request will be completed. NO RUSH FORMS WILL BE ACCEPTED ELECTRONICALLY.
  5. No form will be completed unless a well child checkup has occurred in the past 12 months (an office visit or medication check will not be considered). Please call our office and verify date of last well care if you are uncertain and prior to form submission.
  6. Forms to be completed may be mailed to our Elizabeth Office (1200 East Elizabeth, Fort Collins, CO 80524), dropped off at any one of our four office locations or uploaded here online.  For uploads, we will only accept patient forms (for schools, daycares etc). Please do not upload other office forms such as medical records, registration paperwork, insurance or new patient forms.  Please note the only options to return your submissions will be for us to mail to your home address on file or for you to pickup.

School, Camp Or Daycare Form Upload ONLY: