Stanford Medicine Children's Health — Pediatrics

If your child is a new patient, you will be asked to complete the following form.

• New patient medical history form (PDF)

Well-child visit forms

At some of your child’s regular check-ups, you will be asked to fill out a questionnaire about your child’s health. You can complete these forms in advance by downloading the appropriate questionnaire, filling it out and bringing the completed form to your child’s appointment. Please note that not all recommended check-ups will have forms.

• Well-child check: 2 week visit
• Well-child check: 1 month visit
• Well-child check: 2 month visit
• Well-child check: 4 month visit
• Well-child check: 6 month visit
• Well-child check: 9 month visit
• Well-child check: 12 month visit
• Well-child check: 15 month visit
• Well-child check: 18 month visit
  • 18 month visit MCHAT
• Well-child check: 2 year visit
  • 2 year visit MCHAT
• Well-child check: 2 1/2 year visit
• Well-child check: 3 year visit
• Well-child check: 4 year visit
• Well-child check: 5 year visit
• Well-child check: 6 year visit
• Well-child check: 7 year visit
• Well-child check: 8 year visit
• Well-child check: 9-11 year visit
• Well-child check: 12-17 year visit
• Well-child check: 18+ year visit

Administrative forms

• Authorization to consent to medical treatment of a minor
• Authorization for release of health information in English
• Authorization for release of health information in Spanish

For more information, visit medicalrecords.stanfordchildrens.org.

From Highway 101 South
Exit onto East Poplar Avenue. Turn left onto North San Mateo Drive. 50 South San Mateo Drive will be on your right.

From Highway 101 North
Take the exit toward West 3rd Avenue. Follow signs for 3rd Avenue West/Downtown and merge onto East 3rd Avenue. Turn right onto South San Mateo Drive. 50 South San Mateo Drive will be on your left.

From Highway 280 South
If you are taking 280 South, it is advised to cut over and join US-101 South. Take the Interstate 380 exit toward US-101/SF International Airport. Merge onto 1-380 East. Keep right at the fork, and merge onto US-101 South. Exit onto East Poplar Avenue. Turn left onto North San Mateo Drive. 50 South San Mateo Drive will be on your right.

From Highway 280 North
Take the State Route 92 East exit toward San Mateo/Hayward. Merge onto CA-92 East. Take the California 82 North/El Camino Real exit. Merge onto South El Camino Real. Turn right onto 2nd Avenue. Take the first left onto South San Mateo Drive. 50 South San Mateo Drive will be on your left.