Developmental & Behavioral Pediatrics Questionnaires

New Referrals: Intake Questionnaires

Once a referral has been initiated to our clinic, we will send you a questionnaire in the mail for you to complete and return. When the questionnaire is returned, we will give you a call or send you a MyChart message to confirm your placement onto the wait list for an appointment. If you would like to print a copy of our questionnaire to complete and send in ASAP, please select the appropriate questionnaire below:  

Submitting Completed Paperwork Previous Evaluations

Mail to: 

Division of Developmental Behavioral Pediatrics
225 East Chicago Avenue, Box 119
Chicago, IL 60611-2605


Fax to: 


Existing Patients: Questionnaires

The questionnaires below may be requested by your provider. If you have been asked to complete any of the questionnaires listed below, please save or print a copy as needed.

Vanderbilt Questionnaire Forms

Spence Questionnaire Forms

Scared Questionnaire Forms