Cape Cod Pediatrics Forms

Forms

• Behavioral Health Screens (PEDS, MCHAT, PSC, PHQ-9, Behavioral Assessment, SCARED Child and SCARED Parent) are billable to your insurance company. These forms are completed by the patient or parent and "scored" by the medical provider.
• Beginning at age 14, your child's doctor will complete the Crafft Behavior Screen. There is no form to complete — it is verbal, but it is billable to your insurance company.

Behavioral screening is performed at the recommendation of the State of Massachusetts. If you wish to decline it, you must advise us in advance. All other forms are informational only.

Testing

• At 6 months or age 1, and annually thereafter, we recommend hearing screening (Otoacoustic Emissions Testing).
• Please call your insurance company in advance of the visit to confirm if you will have any cost share.

This is an important test, but if you have a deductible, we want you to have all necessary information before going forward with the testing.

General Forms

• Request for Medical Records to Transfer to or From Cape Cod Pediatrics
• Release of Information Under 18
• Release of Information 18 Years and Older 
• Healthcare Transition from Adolescence to Adulthood

Additional Forms

• SCARED Parent
• SCARED Child
• PHQ-9
• GAD-7
• ADHD Adolescent
• Vanderbilt Teacher
• Vanderbilt Parent