Developmental Behavioral Pediatrics

• Please complete all sections of our registration forms. Accurate and complete information helps us provide the best possible care and avoid delays in your visit.
• Submit all new patient registration forms along with your insurance card and pharmacy benefit card.
• Please be sure to follow all instructions included with the registration forms. This includes how to complete the forms and how to return them to our office. Following these steps helps us process your information quickly.
• If you are completing the forms electronically, please send them back as a single PDF file.
• If you are filling out paper copies, please scan the completed forms as a PDF before sending.
• Please do not send photos of each page, as these can be difficult to read and process.
  • Following these steps helps us review your information quickly and ensure your registration is complete before your visit.
• Your first visit with our office will be a virtual appointment (video visit). This allows us to review your information and discuss your concerns before your in-person evaluation

Here are some tips to prepare for your appointment:

• Bring your child’s favorite toys or books.
• Have a list of your child’s symptoms, including how long they have occurred, how severe they are, and whether they are getting better, worse, or staying the same.
• Bring the list of all medications your child takes, the doses, and how often, including over-the-counter medications and supplements.
• Bring a list of prior medications which the patient has tried and discontinued.
• Make notes of any changes in your child’s behavior, mood, or activity level.
• Write down any questions you want to ask so you don’t forget them.
• We suggest arriving 15 minutes prior to your appointment to ensure ample time to find parking.

Developmental Pediatrics is now offering virtual visits. Here are some tips to prepare for your telehealth appointment:

• Have a list of your child’s symptoms, including how long they have occurred, how severe they are, and whether they are getting better, worse, or staying the same.
• Keep a list of all medications your child takes, the doses, and how often, including over-the-counter medications and supplements
• Have a list of prior medications which the patient has tried and discontinued
• Make notes of any changes in your child’s behavior, mood, or activity level.
• Write down any questions you want to ask so you don’t forget them.
• Know how to log in or initiate the telehealth visit.
• Enable the microphone, speaker, and camera ahead of time to make sure they all work.
• For the appointment, have your child with you in a well-lit room that is quiet and free from distractions.
• Please have your child’s current height and weight available and ready for the day of your appointment.

Please complete forms using Adobe Acrobat.

Submit all new patient intake forms along with your medical and prescription insurance cards, both front and back, to DevelopmentalPediatrics@bchphysicians.org for review prior to appointment.

New Patient:

• Registration/Intake Packet
• Registration/Intake Packet (Spanish)

Dr. Belkin's Forms:

• Under 12: PHQ-A
• Over 12: CRAFFT
• Pediatric Symptom Checklist

Misc. Forms/Tests:

• Vanderbilt Parent - English
• Vanderbilt Parent - Spanish
• Vanderbilt Teacher
• Teacher Report
• Pre-K Report

For everyone:

• Authorization to Release Information
• Authorization to Release Information (Spanish)
• Consent to Treat Patient Without Parent or With Relative
• Consent to Treat Patient Without Parent or With Relative (Spanish)