Your Visit > Forms

Back To School

School Vaccination Information For Parents
School Vaccination Requirements

Welcome Packet

Welcome Packet Part 1 (Read Only)
Welcome Packet Part 2 (Print & Return)

ADHD

ADHD Vanderbilts Parent and Teacher
ADHD Adult Forms

Health Forms

State of Pennsylvania Child Medical Examination
PIAA Sports Physical Form 2019 (Section 5 Health History must be completed by parent for the physician to review)
Non Commercial Drivers License Application

Asthma

Download and complete prior to appointment
Peak Flow Meter Instructions
Asthma Assessment 5 yrs and older
Asthma Control Test
Asthma Follow Up 12 yrs and older
GERD Education

New Patient

Financial Policy
Privacy Policy
Medical Records Request to PAK

Miscellaneous

Informational packet to explain young adults responsibility with his/her account.
Medical Records Release from PAK
Authorizes selected individuals to accompany, provide consent for treatment, and or receive protected health information about the pediatric patient.
Patient Portal Enrollment Form

Is Your Child Sick?TM

WHAT'S GOING AROUND? VISUAL SYMPTOM CHECKER
451 3rd Avenue, SUITE 1 | Kingston, PA 18704 | Phone: 570-288-6543
1081 Oak Street | Suite 1 | Pittston, PA 18640 | Phone: 570-602-PAKP
Copyright © 2019 Pediatric Associates of Kingston, LLC. All rights reserved.
Careers