Sports Physical Exam form
- Minnesota State High School League (MSHSL) Sports Qualifying Physical Exam Form for 2023-2024
- Post Covid Return to Sports Questionnaire
ADHD forms
Initial evaluation for school problems
- Elementary Students (gr. K-5) (includes parent and teacher forms)
- Middle/High School Students (gr. 6-12) (includes patient, parent, and teacher forms)
- Adult (post high-school)
- Teacher Form: Elementary
- Teacher Form: Middle/High School
For patients transferring ADHD care to PIP from another clinic or doctor
- Elementary Students (gr. K-5) (includes parent and teacher forms)
- Middle/High School Students (gr. 6-12) (includes patient, parent and teacher forms)
- Teacher Form: Elementary
- Teacher Form: Middle/High School
Forms for ADHD follow-up appointments
- Elementary Students (gr. K-5) (includes parent and teacher forms)
- Middle/High School Students (gr. 6-12) (includes patient, parent, and teacher forms)
- Adult (post high-school)
- Teacher Form: Elementary
- Teacher Form: Middle/High School
Allergy and asthma questionnaires
Mood Issues/Patient health questionnaires
GAD (Generalized Anxiety Disorder)
PHQ Patient health questionnaires
Other forms
- New patient questionnaire
- Form Completion Request
- Parent and patient questionnaires for well child visits (Find the appropriate questionnaire for your child under the corresponding age group)
- General consent form
- Authorization to consent to treatment – This form will be kept in child’s chart, and includes a place to designate others who may occasionally bring a child in for medical care, such as a daycare provider, grandparent, or others the parent/guardian designates.
- Release of Medical Records Authorization To have records sent to PIP, or from PIP to another clinic
- Children’s Financial Assistance application form and Frequently Asked Questions
- More information on Children’s Financial Assistance program