Child Forms

Vanderbilt 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.

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Talk With Us

To schedule an appointment; call the following clinic sites:

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West Burlington Medical, Pediatric and Dental Clinic

319-768-5858

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Louisa County Medical and Dental Clinic

319-728-7400

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Keokuk Medical and Dental Clinic

319-524-5734

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Hamilton Medical Clinic

217-847-2112

“Clean place went several times to have a tooth pulled after pain overcame me. They took care of me; worked me in. Very nice and gentle Dentists.”

 

J.R.
Patient

“Knowledgeable professionals who truly care for our loved ones good health!”

 

G.G.
Patient

“I love these people at CHC! Great place Good and caring folks.”

 

T.B.
Patient

“I have been using CHC since 2009. I have had excellent care. The Dental clinic team is awesome. Everybody makes you feel at ease and takes their time with you. I will recommend the whole clinic to all of Southeast Iowa.”

 

R.W.
Patient