Forms & Policies
Here you can quickly and conveniently access patient forms from our practice online.
PLEASE NOTE: Participation in the Peapod Membership Program is required to establish Petite Pediatrics as your child’s medical home. Please contact us directly to learn more. You may link to Peapod Membership Program to send us an inquiry.
We utilize an online system, CHADIS, that enables parents to complete patient forms and questionnaires confidentially via the internet and will replace many of the paper forms now administered in the office at the time of your child’s visit.
For parents who do not have access to the internet, the forms may be completed online in the office 30 minutes prior to the scheduled appointment. (Please notify us prior to the visit to arrange for in-office completion of forms.)
Child Health & Development Interactive System
Petite Pediatrics is pleased to announce our new partnership with CHADIS (Child Health and Development Interactive System) which provides parents and adolescents the opportunity to complete health and developmental screening questionnaires online before their office visit.
CHADIS is designed to assist in the early diagnosis of developmental, social, emotional, and behavioral concerns. Parents complete questionnaires before each visit to track their child’s development and to inform us of the topics they want to discuss.
To use CHADIS, please click on the “CHADIS” icon in the left margin.
- Invitation Code
(same as our office number) 8 0 5 8 4 5 1 2 2 1
- New Users
Follow the prompts for the initial registration. You will be asked to create a user name and password for yourself. This protects your confidential information, please keep this for future use.
- Returning Users
Input your secure user name and password.
We will monitor your child’s development at each well child visit and assign age-specific questionnaires. In particular, the American Academy of Pediatrics recommends using standardized screening questionnaires at the 9, 18 and 24-month well-child visits to improve early detection of developmental delays. However, if parents have specific concerns at any age, CHADIS will be used to provide a full evaluation.
Questionnaires will be assigned based upon your child’s age or developmental concern. In order for this diagnostic tool to be successful, we need your help in completing these brief questionnaires at least 3 days before your visit. We will review the results of the questionnaires prior to your visit and be able to address any concerns during the visit. We will also remind you when we call to confirm your appointment to visit CHADIS before your visit. If your child is aged 13 or older, we ask that they complete a questionnaire in addition to the parental questionnaire, both of which are confidential.
As a partner in your child’s health care, your input is essential in helping us to provide your child with the best care possible. As always, we are dedicated to this goal and we feel CHADIS is a great new tool for achieving it.
To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com. Please bring your completed forms with you to our office at the time of your visit.
Download Patient Forms
- Family Demographics (One Per Household)
- Health History or
- Newborn Health History (For Newborns Only)
- Patient Consent
Release of Medical Records