Forms

Medical Records Requests

You may obtain a copy of your medical record created by and/or maintained by your Washington University Physicians provider by clicking here.

New Patient Forms

• New Patient History Form (PDF)
• Patient Registration Information (PDF)

Consent and Communication 

• Consent to Treatment (PDF)
• Patient Communication (PDF)
• Telehealth Consent to Treatment: PDF; Doc

Additional Forms

• Missouri MSHSAA – Sports Participation (PDF)
• IHSA/ IESA Sports Physical Form (PDF)
• Concussion Screen (PDF)

ADHD Forms

• Packets:
  • ADHD Evaluation- Initial Complete Packet (parent and school) (PDF)
  • ADHD Evaluation- Initial Parent Packet (PDF)
  • ADHD Evaluation- Initial School Packet (PDF)
• Individual forms:
  • Vanderbilt Scale- Parent Initial Scale (PDF)
  • Vanderbilt Scale- Teacher Initial Scale (PDF)
  • Classroom Behavior Observation Form (PDF)
  • Educational History Form 2026 (PDF)
  • Vanderbilt Scale- Parent Follow-Up Form (PDF)
  • Vanderbilt Scale- Teacher Follow-Up Form (PDF)