Pediatric Forms + Links


On this page you'll find a variety of resources, forms, and links intended for our patients.


Pediatric Forms

New Patient Packet

Please complete the following forms and either fax or mail to our office along with a copy of your current insurance card.


Annual Demographic Information Update

Please print, complete and bring with you to your child's annual preventative exam.


Daycare Forms


Student Athletic Forms

Upon entering 7th grade most schools require annual completion of this form for all students participating in sports. Please print, complete the entire first page and then bring both pages with you to your child's annual preventative exam for the provider to review and complete.


Release Forms


Neuropsychology forms


Links to Online Resources

The following links to external web sites have been provided for informational purposes only and Rainbow Pediatrics is not responsible their availability or content.

ADOLESCENT HEALTH

The AWARE Foundation - AWARE (Adolescent Wellness through Access to Resources and Education) includes lists of support hotlines for teens to call for help with mental health, sexual abuse, eating disorders, suicide, STDs, emergency contraception, and more: http://www.awarefoundation.com/

I Wanna Know - This sites aims to teach kids about sexually-transmitted diseases before they learn the hard way: www.iwannaknow.org

Planned Parenthood: www.plannedparenthood.org/teens

BREASTFEEDING

La leche league: www.llli.org

BEHAVIOR & DEVELOPMENT

Potty Training Tips - A parent run site, with links to various potty-training pages: www.pottytrainingtips.com

Bedwetting Store for alarms: www.bedwettingstore.com

Sleep Dry bedwetting alarms: www.SleepDryAlarm.com

Development - Links to state, regional, and local early intervention and testing services: www.nectac.org

Development focus on the first three years of life: www.zerotothree.org

The Whole Child, a PBS website featuring articles, ideas for activities, reading lists, forums, etc.: www.pbs.org/wholechild

DENTAL HEALTH

American Academy of Pediatric Dentistry: www.aapd.org

Pediatric Dentistry – Drs Scott Nieman, Carolyn Barber, and Emily Baran at: www.scottniemandds.com

DERMATOLOGY (SKIN)

The National Pediculosis Association, Inc.: www.headlice.org

GENERAL HEALTH

Pediatrician's guide to your children's health and safety: www.KeepKidsHealthy.com

Kids Health: www.KidsHealth.org

Consult the medical resource doctors trust: http://www.uptodate.com/patients

GOVERNMENT

Columbus Health Department: http://publichealth.columbus.gov/

Franklin County Board of Health: http://www.myfcph.org/

Ohio Department of Health: http://www.odh.ohio.gov/

Centers for Disease Control and Prevention: www.cdc.gov

HEART DISEASE

The American Heart Association Children's Health Section: www.americanheart.org/presenter.jhtml?identifier=1477

IMMUNIZATIONS / VACCINATIONS

American Academy of Pediatrics immunization site: http://www.aap.org/immunization

Healthy Children - Today, most children in the United States lead much healthier lives and parents live with much less anxiety and worry over infections during childhood. Immunizations are one of the success stories of modern medicine: http://www.healthychildren.org/english/safety-prevention/immunizations/Pages/default.aspx

The Allied Vaccine Group - Dedicated to educating the public and caregivers exclusively through scientific information: www.vaccine.org

Autism and Vaccines Theory - Addresses the possible connection between autism and vaccination: www.cdc.gov/od/science/iso/concerns/mmr_utism.htm

CDC's Vaccines and Immunizations Page - Designed to be the most comprehensive vaccine site on the internet: www.cdc.gov/vaccines

CDC's Vaccine Safety Page: www.cdc.gov/od/science/iso/

Childhood Immunization Support Project (Run by the AAP): www.cispimmunize.org

The Vaccine Page provides links to web sites that provide valid information and news to parents about vaccines: http://vaccines.org/forparents.htm

From KidsHealth.com, whose information is reviewed by MDs: www.kidshealth.org/parent/general/body/fact_myth_immunizations.html

MENTAL AND EMOTIONAL HEALTH

American Academy of Child & Adolescent Psychiatry –assisting parents and families in understanding developmental, behavioral, emotional and mental disorders affecting children and adolescents: www.aacap.org

Kids Health for Parents: http://kidshealth.org/parent/emotions/

American Association of Suicidology – Dedicated to the Understanding and Prevention of Suicide: www.suicidology.org

Depression: www.depression.org

NUTRITION, FOOD SAFETY, & OBESITY

Nutrition – great ideas on games and activities to keep kids active: www.kidnetic.com

Abbott Nutrition – information on products, education materials, clinical research: http://abbottnutrition.com/

American Obesity Society: www.obesity.org/

Let's Move - Program developed by First Lady Michelle Obama to solve the epidemic of childhood obesity within a generation.: www.letsmove.gov/

Nationwide Children's Hospital Center for Healthy Weight and Nutrition: www.NationwideChildrens.org/HealthyWeight

OPHTHALMOLOGY (EYE)

Conjunctivitis/ Pink Eye information: http://kidshealth.org/parent/infections/eye/conjunctivitis.html

The American Academy of Ophthalmology - Providing authoritative information about eye care for the public and members: www.aao.org/

PREVENTION & SAFETY

Prevent Blindness America - With sections on fireworks, sports, eyewear, and kids' safety measures: www.preventblindness.org

National Poison Control Hotline: www.1-800-222-1222.info/FAQs/home.asp

Central Ohio Poison Center at Nationwide Children's Hospital: www.bepoisonsmart.org

U.S. EPA: www.epa.gov/lead

National Safe Kids Campaign: www.safekids.org

National Highway Traffic Safety Administration – for car seat information click "car seats" under "Browse Topics": www.nhtsa.gov

Car Safety Seats – National Child Passenger Safety Certification program offers a searchable link to inspection sites: http://cert.safekids.org/

Bicycle Helmet Safety Institute: www.bhsi.org

U.S. Consumer Product Safety Commission: www.cpsc.gov

American Society for Testing and Materials - All the fine print standards for toy safety specification: www.astm.org

Dr. Toy: www.drtoy.com

PREGNANCY
PROCEDURES

Ear Piercing – In-office medical piercing systems: www.Blomdahl.com

PROFESSIONAL ORGANIZATIONS AND HOSPITALS

The American Academy of Pediatrics (AAP) – an organization of 60,000 pediatricians committed to the attainment of optimal physical, mental, and social health and well-being for all infants, children, adolescents and young adults. www.aap.org

Nationwide Children's Hospital: www.NationwideChildrens.com

Health Information Translations – A collaborative initiative to improve health education for limited English proficiency patients: www.healthinfotranslations.org

CAP4Kids Columbus - a free website sponsored by local Pediatricians and Nationwide Children's Hospital have that contains a wealth of information about helpful community resources for kids and families.: www.cap4kids.org/columbus
Resource topics include:

  • Mental health resources
  • After school programs/camps
  • Daycare
  • Breastfeeding help
  • Free and discounted prescriptions
  • Low cost health care, travel clinics
  • Smoking cessation programs
  • Obesity resources
  • Teen resources
  • Resources for kids with special needs and much more!
SCHOOL

Assistance locating quality preschool and day care programs: www.childcareaware.org or www.naeyc.org

SPORTS MEDICINE

National Center for sports Safety: www.sportssafety.org

SPOTLIGHT ON SUMMER

Poison Ivy: www.poison-ivy.org

SUBSTANCE ABUSE (Tobacco, Alcohol, Drug Abuse)

Netcare Access provides 24 hour mental health and substance abuse crisis intervention, stabilization and assessment for Franklin County, Ohio residents: www.netcareaccess.org

Tobacco Information and Prevention Source (TIPS): www.cdc.gov/tobacco/

TRAVEL

CDC website for up-to-date travel advisories and information: www.cdc.gov/travel/