The Pediatric Symptom Checklist-17 (PSC-17) is a screening tool used to identify potential behavioral health concerns in children. It is designed to identify children who may benefit from a more thorough developmental evaluation. The M-CHAT-R is a developmental screening tool for toddlers at their 18- and 24-month well check appointments. This short assessment is best completed by the patient’s biological mother, when available. The Pediatric Health Questionnaire-2 (PHQ-2) helps us screen for postpartum depression so that we can offer support if there are concerns. Your health is important for the health of your baby. The postpartum period can be difficult for some parents. Please schedule a visit with your child's primary care provider (PCP) if you need a Certificate of Exemption Form completed that requests exemption from vaccines for personal, philosophical, religious, or medical reasons. However, we do ask that these families sign a Refusal To Vaccinate Form to acknowledge acceptance of responsibility and potential consequences of vaccine refusal. We are committed to discussing vaccinations and preserving relationships with families who decline or alter the recommended vaccine schedule. Immunizations prevent complications, disability, hospitalization, and death from disease. Visit our Childhood Immunizations page for more resources about immunizations. The doctors in our practice know that vaccines, or immunizations, save lives. ![]() ![]() Most schools and daycares in Washington State require a Certificate of Immunization Status (CIS) form for enrollment. Please complete the Immunization Records Request Form above and allow 7-10 business days (Monday - Friday) for our office to complete requests. Please visit our School, Sports, & Camp Physicals page for more information and links to local school district forms. We kindly request that you do not drop forms off at our clinic front desks, as our receptionists will direct you to submit a form request online. ![]() You can find the date of your child’s last Well Child Check-up on their Patient Portal account. Please schedule a Well Child Check-up with your child’s Primary Care Provider (PCP) if your child hasn’t been seen within the requirement on the form and bring any forms you need completed with you to the visit. Please note that out providers are only able to fill out forms for your child if they have been seen in our office for a Well Child Check-up within the last year, or two years if their form allows. The rush fee will not exceed $50 if you need 3 or more forms processed. If you need a form completed faster than our normal processing time, a rush fee of $20 per form will be charged for delivery within 1 business day, Monday - Friday (excluding holidays). You will receive the completed form(s) securely via the email you provide within 3 business days, Monday - Friday (excluding holidays). We encourage all patients to bring any necessary forms with them to their annual Well Child Check-up.Īll form completion requests, including Sports forms, Camp forms, Individualized Health Plans (IHP), and Medication Authorization forms, received outside of a scheduled visit must be submitted electronically using our Patient Form Submission request page.
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