Patient Forms

Bucci Lancer Pediatrics launched a new software program that will require new registration information for all patients. Please review and print and the following documents and bring the completed forms when you arrive for your visit. Otherwise, we recommend you arrive 15 minutes early for your appointment to complete the paperwork:

• Registration Form
• Office Policies and Procedures
• HIPAA Notice of Privacy
• Records Release
• Records Release to Another Office

Additional Forms

• Asthma Test
• Adult ADHD Self Assessment
• Child ADHD Assessment - Teacher Form
• Child ADHD Assessment - Parent Form
• Depression Screen
• Screen for Child Anxiety Related Disorders (SCARED) Form
• Ages and Stages Questionnaire -9 Months
• Ages and Stages Questionnaire -18 Months
• Ages and Stages Quesionnaire - 24 Months
• M-Chat-R Form for Ages 18 and 24 Months

In order to view or print these forms you will need Adobe Acrobat Reader installed.
Click here to download it.