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MEDICAID NOTICE: Lurie Children’s continues to serve all patients enrolled in Medicaid. As a safety-net hospital, we will continue providing high-quality care to every child who needs us.

AVISO SOBRE MEDICAID: Lurie Children’s continúa atendiendo a todos los pacientes inscritos en Medicaid. Como hospital perteneciente a la red de protección social, continuaremos brindando atención de alta calidad a cada niño que nos necesite.

Lurie Children’s Home Specialties & ConditionsDevelopmental & Behavioral Pediatrics Questionnaires

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

OR

Fax to: 

312.227.9271

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