Crestview Hills, Kentucky
513-820-2312 (after hours)
859-578-3172 Fax

Online Forms and Practice Resources for Pediatric Patient Families

This location contains practice forms and handouts. Please see "Well Child Checkups" for age specific handouts and forms.


We recommend an evaluation with a psychologist to confirm the diagnosis of ADHD and exclude other problems. We use ratings scales for diagnosis and then to monitor treatment. The form below is a consent form as required by Kentucky law (KASPER law). For more information on ADHD go to our Websites and Handouts section.


Influenza (Flu) Vaccine Consent Form

Foster Care

Records Release

Sports Physical Forms

Medical Home Information for New Patients


All families who have children with asthma are asked to complete the top portion of this form annually. The information on this form helps us to ensure our patients with asthma have good control of their symptoms. You may complete this form prior to your child's visits and bring it in with you.


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Pediatric Associates PSC - Crestview Hills | 2865 Chancellor Drive | Suites 225 (Upstairs) and 120 (Down Under) | Crestview Hills, KY 41017 | Phone: 859-341-5400 | Fax: 859-578-3172
Pediatric Associates PSC - Mt. Zion Road | 9920 Berberich Drive | Florence, KY 41042 | Phone: 859-341-5400 | Fax: 859-578-3172
Pediatric Associates PSC - Cold Spring | 175 French Street | Cold Spring, KY 41076 | Phone: 859-341-5400 | Fax: 859-578-3172
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