Behavioral health documents
Please complete the form(s) requested by your provider and submit them via MyChart.
To submit:
- Reply to the original MyChart message you received.
- Click blue button that says “attach image or video.”
- Upload all document you want to send in your reply
If you are unable to upload the forms via MyChart, please email the completed forms to pnw.secure@pedinw.org and also send a MyChart message letting us know that you submitted the forms through email.
Initial intake paperwork
- FORM A. Behavioral Health Intake Form- Online version OR Behavioral Health Intake Form- Print out version
- FORM B. Vanderbilt – Parent
- FORM C. Vanderbilt – Teacher
- FORM D. SCARED – Child
- FORM E. SCARED – Parent