School & Sports Forms
Requests for school entrance or VHSL sports forms will incur a $20 fee if not completed at wellness visit. Ask for forms during your visit to avoid the charge!
School Forms
ADHD Evaluation
Complete pgs. 4 & 5 prior to your visit / form drop-off
VHSL updated the sports form as of April 2025. Read below for more information.
Providers utilize various ADHD evaluation forms. Forms must be returned to the office 1 week prior to your visit for review. Please use the form preferred by your PCP.
​Note: Most providers utilize Vanderbilts unless specified otherwise. Also, Daphne Damen CPNP does not offer ADHD evaluation testing
​Note: Dr. Nur requests only a note from parent(s) and teachers describing the concerning behaviors they are seeing.
Paperwork
For Your
Visit
Completing this form helps us obtain up to date contact information and allows consent for additional adults to make decisions in your absence.
The provider's stance on seeing minors for urgent, “sick” visits, or in cases when the adolescent patient has the legal authority to provide consent.
Form to authorize a minor to be seen by provider without a parent present.
Keeping a record of when headaches occur can help the provider diagnose the cause.
Please complete this form for your first visit to inform the provider of any relevant medical history.
Use this form to authorize someone not previously approved to bring your child for a visit and make medical decisions in your absence
To be completed by patients upon turning 18 to designate individuals authorized to access their medical information.
To inform patients about telehealth services, including risks, benefits, and their rights, and documents their agreement to receive care remotely.