Paperwork, made painless.
Download the form
Fill out the PDF on your device, print it at home, or pick up a copy at the front desk.
Fill it out & sign
Complete every field and sign it. A parent or legal guardian must sign for patients under 18.
Send it back
Email the signed form to info@princetonpediatricstx.com or drop it off at the office.
Medical Records Release Form
This form gives us your written permission to share your child's medical records — either to request their history from a previous doctor, or to send our records to another provider. A parent or legal guardian completes and signs it.
You'll need this form if:
- You're joining our practice and your child's records are with a previous pediatrician.
- A specialist or another provider needs a copy of your child's chart.
- You're moving or transferring to a new practice and need records sent there.
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Vanderbilt ADHD Assessment
The Vanderbilt Assessment Scale is a standardized questionnaire that helps Dr. Moolji evaluate your child for ADHD. A parent and one of your child's teachers each fill out their own version, rating how often certain behaviors show up. Follow-up versions are included too, for tracking how well treatment is working.
You'll need this form if:
- Dr. Moolji has asked you to complete an ADHD evaluation for your child.
- A parent and one of your child's teachers each need to rate their behavior.
- You're following up to track how well ADHD treatment is working.
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Newborn Circumcision Consent
This is your written consent for Dr. Moolji to perform an elective newborn circumcision at Princeton Pediatrics. It walks through the technique used, how we manage your baby's pain, and the benefits and risks — so you can make an informed decision. A parent or legal guardian signs it before the procedure.
You'll need this form if:
- You're planning to have your newborn son circumcised at our office.
- You want to review how the procedure works, along with its benefits and risks, in advance.
- You're the parent or guardian who will give consent before the procedure.
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