We are accepting new patients! : Click the link below to register your child or baby (only after he/she is born). If you are registering a newborn, please call the office and push extension 2 after clicking the link and filling out the information.* Once we receive your information, the office will reach out to you to let you know when you can schedule your child's first appointment. You can establish care with a well exam or a sick visit. We are in-network with most commercial insurance plans and highly recommend contacting your insurance provider to verify we are in-network with your specific plan. We are not in-network with any Medicaid plans. *After registering, please watch your email for your welcome notice and be sure to complete your portal registration - Please click here to begin New Patient Registration!

Serving the Metro East and surrounding areas.

224 Bradford Lane, Waterloo. IL 62298

Call Or Secure Text Us At(618) 939-0112

Resources

HomeResources

New Patient Forms

*Please make sure that you either fill out the Online New Patient Registration Form OR if you choose, you may choose to Download & Print the New Patient Registration Packet. Please choose one or the other.

Click here to begin New Patient Registration

Download & Print New Patient Registration Form

Medical Records Request/Release

Well Visit Forms

Ages & Stages Form - 9 months

Ages & Stages Form - 18 months

Ages & Stages Form - 30 months

Childhood Lead Risk Questionnaire

Edinburgh Postnatal Depression Scale

MCHAT - Autism Screening For Toddlers

Tuberculosis (TB) Risk Assessment Form

Patient Health Questionnaire-2 (PHQ2)

Dyslipidemia Screening

Specialty Forms

ADHD Vanderbilt - Parent Initial

ADHD Vanderbilt - Parent Follow Up

ADHD Vanderbilt - Teacher Initial

ADHD Vanderbilt - Teacher Follow Up

PHQ9 - Questionnaire for Depression

OCD Assessment - Yale Brown

Scared Parent Form

Scared Child Form

Helpful Information & Handouts

Over The Counter Medication Dosage Chart

Starting Solids

Current Vaccine Information Sheets

Recommended Well Visit Screening Schedule

Age	Recommended Screenings & Forms
1 Month	Edinburgh (mom to fill out about herself) TB Risk Assessment
2 Months	Edinburgh (mom to fill out about herself)
4 Months	Edinburgh (mom to fill out about herself)
6 Months	Edinburgh (mom to fill out about herself) Lead Risk Assessment TB Risk Assessment
9 Months	Lead Risk Assessment
12 Months	Lead Risk Assessment TB Risk Assessment
18 Months	MCHAT Lead Risk Assessment
24 Months	MCHAT Lead Risk Assessment TB Risk Assessment Dyslipidemia Screening
36 Months	Lead Risk Assessment TB Risk Assessment
4 Years	Lead Risk Assessment TB Risk Assessment Dyslipidemia Screening
5 Years	Lead Risk Assessment TB Risk Assessment
6 Years	Lead Risk Assessment TB Risk Assessment Dyslipidemia Screening
7 Years and older	PHQ-2 (to be filled out during visit) Dyslipidemia Screening