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WASHINGTON UNIVERSITY CLINICAL ASSOCIATES

Arch Pediatrics

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Forms

Please print and complete any needed forms and bring them with you to your next office visit.

  • Request a Copy Your Medical Records (for yourself) (PDF)
  • Request Medical Records Release (to a third party) (PDF)
  • Adolescent Health Survey Form (PDF)
  • Patient Information Record (PDF)
  • M-CHAT Survey (PDF)
  • Patient Communication Form (PDF)
  • Influenza Vaccination Consent Form (PDF)
  • Screen for Child Anxiety Related Disorders (SCARED) (PDF)
  • Vanderbilt Assessment Scales (ADHD) – Parent Form (PDF)
  • Vanderbilt Assessment Scales (ADHD) – Teacher Form (PDF)

Arch Pediatrics

Washington University Clinical Associates (WUCA)

3844 S. Lindbergh Blvd.

Suite 216

St. Louis, MO, 63127

314-525-0580

©2023 Washington University in St. Louis