Well Child

Paperwork for Well Child Checks (Physicals)

Please complete the appropriate forms for children prior to the Well Child Check. Forms are grouped by age; and all forms in each age group need to be completed. These forms are fillable PDF files allowing you to complete them on the computer and print them on your home printer. They cannot be saved with Acrobat Reader. You may print the forms and fill them out by hand.

PDQ or Prescreening Development Questionnaires are not yet available online. We hope to add these forms, but they are copyrighted and we do not have the license in place yet. Please contact the office for hard copies prior to each well child appointment.

Parents who come in with these forms already completed generally are able to reduce their time in the waiting room and in the office. This also allows you to find information that may not be readily available if you were to complete them in office. In addition, the Well Child checklist below will help you organize for the appointment.

Well Child Check Preparation:

1. Paperwork and forms completed and signed where indicated. Please bring them with you!
2. Parent drivers license and/or other picture identification.
3. Patient current insurance card(s) for a plan accepted by Ponderosa Pediatrics (click here for list).
4. Immunization (shot) records.
5. Be ready to pay any insurance required copayments at check in.
6. If the patient does not have insurance, payment in full is expected at the completion of the visit. Patients paying in full at the time of visit receive a prompt pay discount.

Newborn and Two Week Check (click form to download):

Two Month & Four Month Checks (click form to download):

Six Month & Nine Month Checks (click form to download):

12 Month, 15 Month, & 18 Month Checks (click form to download):

24 Month & 3 Year Checks (click form to download):

 4  & 6 Year Checks (click form to download):

Annual Checks from age 7-18 (click form to download):