Give parents and guardians the freedom to complete the Pediatric Symptom Checklist with any device, anywhere. Enable them to answer sensitive questions in privacy at a comfortable and unhurried time.
Easily personalize this form template with our HIPAA compliant form builder.
Start saving time and money with FormDr
This form enables parents and guardians to express the changes they are seeing in their child’s behavior, emotions, or learning. Because parents/guardians know their children best, this is vital information for the provider to form a plan of care for the child.
A child’s daily functioning is an expression of their strengths and stressors. A child’s functioning is the common pathway for the influence of genetics, their psychological development, social determinants of health, coping abilities, and resilience.
The liability falls on you to handle patient data in a compliant way. Patient privacy is a serious topic, legislation from the Health Insurance Portability and Accountability Act to the Patient Protection and Affordable Care Act place heavy fines on medical professionals who mistreat patient information.
A medical release form does not empower your staff to share patient information with just anyone. Depending on what is included in the form, the document may release medical information to the patient’s family, other doctors, insurance providers, attorneys, or anyone who may make healthcare decisions on behalf of the patient.
FormDr’s CRM for healthcare empowers providers with a centralized system to store, track, and manage patient interactions effortlessly. With automated appointment scheduling, real-time patient history access, and intelligent communication tools, you can ensure personalized care while reducing administrative burdens.
Collect electronic patient signatures before the appointment. Easily give your patients the ability to digitally sign from their phone, tablet, or computer.
Quickly and efficiently collect patient payments using a HIPAA-compliant payment processing widget with reporting capabilities and the easy customizations you expect from FormDr.
Keep a detailed record of your account and export your history as a CSV Excel file or Google Sheet. Quickly export every event from your account; or, select a date range or user’s history to export.
FormDr gives your practice everything needed to easily send and receive HIPAA compliant forms online. We help practices who: