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 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

New Patient Intake Form – Pediatric Only