New Patient Forms

Demographic Form

VFC form

Medical History Form

Flu Vaccine Consent Forms

child

adult

Medical Forms

COVID vaccine forms

COVID testing child

COVID testing adult

COVID testing procedures (non Tosa Pediatric students)

COVID testing WSD staff and families

Records Release Form (request to send records from Tosa Pediatrics

Medical Records Release Form (request to send records to Tosa Pediatrics)

Allergy/Anaphylaxis Action Plan

ADHD Vanderbilt Assessment Scales (click "Download Now", print, and distribute to "Parent" or "Teacher" as indicated)

PHQ-9 Depression Screen

SCARED - Childhood Anxiety Screen (Child version)

SCARED - Childhood Anxiety Screen (Parent version)

HIPAA Records Release Authorization (fax or send to the physician's or provider's office who you wish to release records)

Sport Concussion Assessment Tool (SCAT 2)

Daycare Forms

Daycare Health Report

Extracurricular Activity Forms

Wauwatosa Sports Participation Cards

     - Senior high

     - Senior high alternate year

     - Middle School

WIAA Sports Participation

Boy Scout Camp

Girl Scout Camp