Patient Forms &
Documents
Everything Dr. Marie needs from your family — organized, secure, and accessible whenever you need it.
Pediatric Intake Form
Complete health history, family medical background, home environment, and support systems. Required for all new patients before their first visit with Dr. Marie.
Developmental Screening
Age-appropriate ASQ-3 questionnaires tracking your child’s milestones across communication, motor skills, problem solving, and social development. Completed online and scored securely.
The S.T.A.R. Review
The Social Toddler Assessment Review — a focused behavioral and social-emotional check-in for toddlers. Helps Dr. Marie understand how your child is connecting, communicating, and engaging with the world.
Record Release
Authorize the transfer of your child’s medical records to or from Dr. Marie. Required when transitioning from a previous provider or coordinating care with a specialist.
Leucovorin Consent
Informed consent for off-label use of Leucovorin (folinic acid). Complete this before your child’s first treatment. Dr. Marie will walk you through the details at your visit.
Postpartum Depression Screening
Edinburgh Postnatal Depression Scale (EPDS). A confidential 10-question screening to help Dr. Marie assess how you’ve been feeling in the past 7 days. Scored securely with 14‑day auto‑purge.
Pediatric Symptom Checklist
A brief behavioral and emotional screening for children ages 4–16. Helps Dr. Marie identify concerns with attention, anxiety, and conduct early — so your child gets the right support at the right time.