Child Forms
Note to Parents
If your child is scheduled for an appointment with a provider at one of our clinics to be evaluated for Attention Deficit Hyperactivity Disorder, also known as ADHD. You MUST fill out the Vanderbilt evaluation forms prior to the appointment. Please make sure to complete your form and ensure that your child’s teacher complete theirs.
Please remember that Community Health Centers of Southeastern Iowa, Inc (CHCSEIA), like other health organizations, depends on scheduled appointments in order to provide quality care to all of its patients. Every scheduled appointment is time specifically reserved for the provider and that patient. If you find that you were not able to complete the required forms prior to this visit, please call to reschedule.
It's our privilege to be a member of your health care team and we look forward to seeing at your scheduled appointment.
Sincerely,
Community Health Centers of Southeastern Iowa, Inc.
AcknowledgeTalk With Us
To schedule an appointment; call the following clinic sites:
West Burlington Medical, Pediatric and Dental Clinic
319-768-5858
Louisa County Medical and Dental Clinic
319-728-7400
Keokuk Medical and Dental Clinic
319-524-5734
Hamilton Medical Clinic
217-847-2112