Litchfield County Pediatrics

20 Felicity Lane
Torrington, CT 06790

Patient Forms
To expedite your first appointment, please arrive a few minutes early to complete registration forms so that we have all the necessary information to treat your child. You may also download and print the forms from this website, fill them out ahead of time, and bring them with you to the first appointment.
NOTEPlease fill out parent section of form before giving it to us for review/completion.  Thank you!!

 

  • Medical Action Plans and Questionnaires
    • Asthma Action Plan (0-11 years) or (over 12 years)
    • Allergy Action Plan (English) or (Spanish)
    • Asthma assessment (young kids) or (older kids) (coming soon)
    • ADHD Vanderbilt Forms for Parents and Teachers - choose from below:

AAP - Vanderbilt - Parent Form
AAP - Vanderbilt - Teacher Form
AAP - Vanderbilt - Parent Follow-up Form
AAP - Vanderbilt - Teacher Follow-up Form

In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.