Paperwork, in advance
Forms.
Every form we use, in one place. Fill them in before you come and you will not be doing paperwork on a clipboard with a toddler on your lap.
Submit
Portal or front desk
Turnaround
Same day, mostly
Format
Online and PDF
Spanish
Available on request
Paperwork, in advance
Forms.
Every form we use, in one place. Fill them in before you come and you will not be doing paperwork on a clipboard with a toddler on your lap.
Submit
Portal or front desk
Turnaround
Same day, mostly
Format
Online and PDF
Spanish
Available on request
Paperwork, in advance
Forms.
Every form we use, in one place. Fill them in before you come and you will not be doing paperwork on a clipboard with a toddler on your lap.
Submit
Portal or front desk
Turnaround
Same day, mostly
Format
Online and PDF
Spanish
Available on request
NEW PATIENT PAPERWORK
New patient paperwork
NEW PATIENT PAPERWORK
New patient paperwork
NEW PATIENT PAPERWORK
New patient paperwork
WELL-CHECK SCREENERS
Well-check screeners
M-CHAT
Autism screening, 18 and 24 months
Open
SCARED — parent
Anxiety screening, parent version
Open
SCARED — child
Anxiety screening, child version
Open
Edinburgh Postnatal Depression Scale
For parents, at newborn and infant visits
Open
GAD-7
Generalised anxiety screening
Open
PSC-17
Pediatric symptom checklist
Open
PHQ-9 — modified for teens
Depression screening, adolescent
Open
PHQ-9 — adult
Depression screening, adult
Open
WELL-CHECK SCREENERS
Well-check screeners
M-CHAT
Autism screening, 18 and 24 months
Open
SCARED — parent
Anxiety screening, parent version
Open
SCARED — child
Anxiety screening, child version
Open
Edinburgh Postnatal Depression Scale
For parents, at newborn and infant visits
Open
GAD-7
Generalised anxiety screening
Open
PSC-17
Pediatric symptom checklist
Open
PHQ-9 — modified for teens
Depression screening, adolescent
Open
PHQ-9 — adult
Depression screening, adult
Open
WELL-CHECK SCREENERS
Well-check screeners
M-CHAT
Autism screening, 18 and 24 months
Open
SCARED — parent
Anxiety screening, parent version
Open
SCARED — child
Anxiety screening, child version
Open
Edinburgh Postnatal Depression Scale
For parents, at newborn and infant visits
Open
GAD-7
Generalised anxiety screening
Open
PSC-17
Pediatric symptom checklist
Open
PHQ-9 — modified for teens
Depression screening, adolescent
Open
PHQ-9 — adult
Depression screening, adult
Open
ASTHMA AND INHALER TECHNIQUE
Asthma and inhaler technique
ASTHMA AND INHALER TECHNIQUE
Asthma and inhaler technique
ASTHMA AND INHALER TECHNIQUE
Asthma and inhaler technique
Getting them to us
Three ways to send a form back.
Whichever is easiest. The portal is fastest and it is the only one that is secure.
Patient portal
Upload a signed PDF or complete an online form. Secure, and it lands in your child’s chart automatically.
At the front desk
Bring it in. We will scan it while you wait and hand the original back.
By post
6190 S Fort Apache Rd, Las Vegas, NV 89148. Slowest, but it works.
Getting them to us
Three ways to send a form back.
Whichever is easiest. The portal is fastest and it is the only one that is secure.
Patient portal
Upload a signed PDF or complete an online form. Secure, and it lands in your child’s chart automatically.
At the front desk
Bring it in. We will scan it while you wait and hand the original back.
By post
6190 S Fort Apache Rd, Las Vegas, NV 89148. Slowest, but it works.
Getting them to us
Three ways to send a form back.
Whichever is easiest. The portal is fastest and it is the only one that is secure.
Patient portal
Upload a signed PDF or complete an online form. Secure, and it lands in your child’s chart automatically.
At the front desk
Bring it in. We will scan it while you wait and hand the original back.
By post
6190 S Fort Apache Rd, Las Vegas, NV 89148. Slowest, but it works.
Please do not email us a completed form
Ordinary email is not a secure channel, and a completed form carries your child’s protected health information. Use the portal, bring it in, or post it. If you have already emailed one, call the office and we will tell you what to do next.
Please do not email us a completed form
Ordinary email is not a secure channel, and a completed form carries your child’s protected health information. Use the portal, bring it in, or post it. If you have already emailed one, call the office and we will tell you what to do next.
Please do not email us a completed form
Ordinary email is not a secure channel, and a completed form carries your child’s protected health information. Use the portal, bring it in, or post it. If you have already emailed one, call the office and we will tell you what to do next.
Joining the practice?
Start with the new patient registration form, then book. Doing it in that order means your first visit is a visit, not an intake.
Joining the practice?
Start with the new patient registration form, then book. Doing it in that order means your first visit is a visit, not an intake.
Joining the practice?
Start with the new patient registration form, then book. Doing it in that order means your first visit is a visit, not an intake.
Locally owned pediatric care for Las Vegas families since 1995.
Same-day sick visits, six days a week.
Book online, or call 702-564-8556.
Book an Appointment
© 2026 St. Rose Pediatrics. All rights reserved.
This website is for general information only and is not medical advice. For a medical emergency call 911. Please do not send protected health information through the contact form.
Locally owned pediatric care for Las Vegas families since 1995.
Same-day sick visits, six days a week.
Book online, or call 702-564-8556.
Book an Appointment
© 2026 St. Rose Pediatrics. All rights reserved.
This website is for general information only and is not medical advice. For a medical emergency call 911. Please do not send protected health information through the contact form.
Locally owned pediatric care for Las Vegas families since 1995.
Same-day sick visits, six days a week.
Book online, or call 702-564-8556.
Book an Appointment
© 2026 St. Rose Pediatrics. All rights reserved.
This website is for general information only and is not medical advice. For a medical emergency call 911. Please do not send protected health information through the contact form.
Locally owned pediatric care for Las Vegas families since 1995.
Same-day sick visits, six days a week.
Book online, or call 702-564-8556.
Book an Appointment
© 2026 St. Rose Pediatrics. All rights reserved.
This website is for general information only and is not medical advice. For a medical emergency call 911. Please do not send protected health information through the contact form.
