1442 South A Street • Springfield, OR 97477     Tel: 541-726-4100 • Fax: 541-726-4900
Back to McKenzie Pediatrics

Office Hours

Monday through Fridays 8:30 a.m. to 5:30 p.m.
Babies and Teens and In-Betweens!

Patient Forms

You can open and print the following files using Adobe Acrobat Reader. If you don't have the reader installed on your computer, you can download a free copy of Acrobat Reader here.

12-Month Developmental Questionnaire   [View this form]
Please download, complete, and bring to your child's 12-month well-child check!
24-Month Developmental Questionnaire   [View this form]
Please download, complete, and bring to your child's 24-month (2 Year) well-child check!
ADHD Questionnaire For Parents   [View this form]
ADHD Questionnaire For Teachers   [View this form]
Adolescent Depression Questionnaire   [View this form]
Adolescent Girl Questionnaire   [View this form]
Adolescent Guy Questionnaire   [View this form]
Anxiety Questionnaire   [View this form]
Asthma Questionnaire   [View this form]
Autism Questionnaire   [View this form]
Headache Questionnaire   [View this form]
Medical Records Release   [View this form]
New Patient Questionnaire   [View this form]
New Patient Registration   [View this form]
Notice of Privacy Practices   [View this form]
Welcome Page & Clinic Information   [View this form]

  
1442 South A Street • Springfield, OR 97477     Tel: 541-726-4100 • Fax: 541-726-4900