618-281-HEAL
Save time by filling out these forms before you arrive
for your first appointment!
Registration form
Health History
Consent to Treat
Read the
Privacy Polic
y
and
No-
Show Policy
and
sign the
form
.
Print and sign this
form
if you
need us to get your old
records
for you.
Ages and Stages Questionnaire
4 month
6 month
9 month
12 month
15 month
18 month
2 year
30 months
3 year
4 year
5 year