Pediatrics Intake Forms
Every pediatric intake form a practice uses, explained: what each one asks and why.
From the newborn first visit and well-child questionnaires to developmental screening and subspecialty forms. Pick a form to see its questions.
Pediatrics intake forms by area
Forms grouped by the part of pediatric care that uses them. Every practice words its own forms differently; each page shows what a typical form asks.
- Well-child visits 6
- New patient forms 2
- Sick and sports visits 2
- Screening tools 5
- Common childhood concerns 3
- Pediatric subspecialties 8
- Pediatric surgery 2
Well-child visits
6 forms- 2 month well baby visit questionnaire Coming soon
- 12 month well child questionnaire Coming soon
- 18 month well child visit Coming soon
- Newborn first visit questionnaire Coming soon
- School age well child visit questionnaire Coming soon
- Well child visit questionnaire Coming soon
New patient forms
2 forms- Pediatric new patient form Coming soon
- Teen new patient health history form Coming soon
Sick and sports visits
2 forms- Sick child visit intake Coming soon
- Sports physical history form Coming soon
Screening tools
5 forms- ASQ developmental screening questionnaire Coming soon
- Developmental pediatrics new patient form Coming soon
- M-CHAT autism screening toddler Coming soon
- PHQ-A teen depression questionnaire Coming soon
- Vanderbilt ADHD parent form Coming soon
Common childhood concerns
3 forms- Child bedwetting questionnaire Coming soon
- Child constipation questionnaire Coming soon
- Pediatric headache questionnaire Coming soon
Pediatric subspecialties
8 forms- Pediatric cardiology new patient form Coming soon
- Pediatric dermatology new patient form Coming soon
- Pediatric diabetes new patient form Coming soon
- Pediatric endocrinology new patient form Coming soon
- Pediatric epilepsy new patient questionnaire Coming soon
- Pediatric gastroenterology new patient form Coming soon
- Pediatric neurology new patient form Coming soon
- Pediatric urology new patient form Coming soon
Pediatric surgery
2 forms- Child pre-op questionnaire Coming soon
- Pediatric surgery new patient form Coming soon
Pediatrics intake forms: FAQ
What intake forms does a pediatric practice use?
Most practices start with a new patient form and a well-child questionnaire for each checkup age. Many add screening tools for development, autism, ADHD and teen mood, plus forms for sick visits, sports physicals and subspecialty referrals.
Who fills in pediatric intake forms?
Usually a parent or guardian answers for the child. Teens often answer some questions themselves, and many practices give adolescents a separate health history so they can speak about sensitive topics more freely.
How are well-child questionnaires different from a new patient form?
A new patient form collects the child's full history once: birth, illnesses, medicines, allergies and family history. A well-child questionnaire is shorter and repeats at each checkup, asking about growth, feeding, sleep, milestones and safety for that age.
Which screening questionnaires do pediatricians use?
Common tools include the ASQ for development, the M-CHAT for autism in toddlers, Vanderbilt rating scales for ADHD and the PHQ-A for teen depression. The AAP recommends autism-specific screening at the 18 and 24 month visits.
How does AI Doctor help a pediatric practice?
AI Doctor, a real-time AI healthcare assistant avatar, asks the intake questions as a conversation, in the patient's own language, and collects the answers for the team to review. Parents can answer for their child before the visit.
Which form should a new pediatric practice start with?
Start with the pediatric new patient form, since every child needs one. Then add the well-child questionnaires for the ages you see most, and the screening tools your checkup schedule calls for.
Does AI Doctor give medical advice?
No. It collects information for the care team. It doesn't diagnose, triage, or recommend treatment.
Can patient answers stay on our own servers?
Yes. RAVATAR offers on-prem deployment: the platform can run inside your own perimeter, so patient answers stay there. RAVATAR complies with GDPR and the EU AI Act.
Set up your AI Doctor in Genesis AI Avatar Studio
Genesis AI Avatar Studio is where you set up, test, and publish AI avatars for your website, mobile app, or Holobox. No coding or technical skills needed.
- 01Choose the AI Doctor avatar.
- 02Add your practice's FAQs and visit information.
- 03Talk to it, then publish it.
