Please click on the forms below that we have asked you to complete for your upcoming visit.
Once you have completed the forms, you may print them and mail them to us or download the PDF and email it to us at firstname.lastname@example.org. This is a secure email and will protect your confidential medical information. Please include your name and date of birth in your e-mail.
If you have any problems, please contact us at 802-295-6132.
Asthma Control Test Forms
Ages & Stages Developmental Questionnaires
Annual Wellness Questionnaire
These questions should be completed by Medicare patients and adults 65 and older prior to a yearly wellness exam
Patient Health Questionnaire
This form should be completed by adults 64 years of age or younger prior to a yearly wellness exam, diabetes visit or asthma check-up
Screening for Anxiety
Social Needs Screening Tool
Attention-Deficit /Hyperactivity Disorder Questionnaires
Medical Release Form