FORMS & RESOURCES

All of the paperwork needed to obtain optimal care at Panda can now be completed online without entering the office or touching a paper. Medical convenience means improved safety, healthcare, and satisfaction. We hope you like this new improvement!

General Forms

New Patient Forms

• Consent and Acknowledgements Form

• Insurance Form

• Sliding Fee Schedule

• Privacy Requests and Consents

• New Patient Registration Form

• Medical History Questionnaire

Miscellaneous Forms

• Kansas State High School Activity Association Participation Form

  • Please place parent / guardian signature on form prior to our review

• Family and Medical Leave Form

• Release of Information

Specific Health Screening Forms

Depression

• PHQ-9 Form

Attention Deficit Hyperactivity Disorder (ADHD)

• Vanderbilt Assessment Parent - Initial

• Vanderbilt Assessment Teacher - Initial

• Vanderbilt Assessment Parent - Follow Up

• Vanderbilt Assessment Teacher - Follow Up

Anxiety

• SCARED Form - Parent Version

• SCARED Form - Child Version

Autism

• MCHAT-R Form

Postpartum Depression Screening

• EPDS Form

EXTERNAL RESOURCES

Building a Foundation for Healthy, Active Living

Discipline and Your Child

Temper Tantrums

Divorce and Children

How to Handle Anger

Learning Disabilities

Parenting Anxious Children

Single Parenting

Dealing with a Traumatic Event

Preparing your family for a new child

Referral Documents (Nurse Use Only)

CCHD Referral Form