Established Patient Forms

Prior to your appointment, please fill out the forms below for every follow-up visit. This will save time and provide a contactless check-in process.
 
To complete pre-visit forms before your next appointment with us, simply click on the form you’d like to fill out, fill in the responses for your child (please complete all checkboxes and spaces for written answers), and a “sign” button will appear when the form is completed. Hit “sign” and you’re done! 
 
No “sign” button? Check to make sure that you’ve filled in commonly missed information like name, date of birth, and signature. The button will only appear when all required spaces have been completed.

General

Respiratory Symptoms Pre-Visit Questionnaire

Asthma Patient

Pre-Visit Questionnaire Form

Pre-Visit Questionnaire 

Asthma Control Test

Child Asthma Control Test*
*CACT (To be filled out by all asthma patients 4-11 years of age)

Asthma Control Test*
*ACT (To be filled out by all asthma patients over 12 years of age)

Cystic Fibrosis (CF) Patient

Pre-Visit Questionnaire

Birth – 11 years of age

12 – 18 years of age

Primary Ciliary Dyskinesia (PCD) Patient

Pre-Visit Questionnaire

Birth – 11 years of age

12 – 18 years of age