ADC Pediatrics
Patient Forms

Save time and complete your form ahead of time.  Just print the forms below, complete and bring to your visit.

Pediatric New Patient Form (PDF)

Prenatal Questionnaire (PDF)  (Word)

ADD New Patient Form (PDF) (Word)

NICHQ Vanderbilt Assessment Scale Parent Info (PDF)

NICHQ Vanderbilt Assessment Scale Teacher Info (PDF)

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School Physical Forms 2011-2012
ADC Pediatrics is now accepting appointments for camp/sports/band/school physicals.  The following links will take you to a website outside of adclinic.com

	Austin ISD Physical Form (Eng)  (Espanol)
	Bastrop ISD Physical Form
	Blanco ISD Physical Form
	Dripping Springs ISD Physical Form
	Eanes ISD Physical Form
	Georgetown ISD Physcial Form (Athletics)
	Hays CISD Physical Form
	Hutto ISD Physical Form
	Lake Travis ISD Physical Form
	Leander ISD Physical Form
	Pflugerville ISD Physical Form
	Round Rock ISD Physical Form
	Smithville ISD Athletics Page

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Medical Records

To transfer your records to our office, please download the
Medical Records Release Form (PDF) (Word) below.

Form Fees
There is a charge for the following forms:

	Copy of Immunization Record (outside of a well check)
	Copy of Medical Records
	Completion of Health Forms (outside of a well check)
	Prescription re-writes for ADD medications

Click here to download Adobe Acrobat Reader for PDF forms.