Forms to Complete For Your Well Visit

All patient should complete the GCPA Family History form

• For 16, 20 and 24 month Well Visits, please complete the M-CHAT form
• For 4 – 17 Year Old Well Visits, please complete the PSC-17 form
• For 18+ Year Old Well Visits, please complete the PHQ-9 form
• For 1 month Well Visits, please complete the EPDS form
• For 2, 4, 6, 9, 12, and 16 month Well Visits, please complete the BPSC form
• For 20 month, 2 Year, and 3 Year Old Well Visits, please complete the PPSC form

Print out and complete the forms and bring to the office for your well visit. If you are set up on the GCPA Patient Portal, the forms can be completed online.