Patient Forms

Thank you for choosing A to Z Pediatric and Youth Healthcare as your child's medical home, where we always provide a comfortable, caring environment so our patients and their families can feel at ease. We've included helpful items on this page to ensure you and your child's first trip to our office is productive, stress-free and enjoyable.

Our compassionate Addison and Brookfield, IL pediatricians and nurse practitioners do whatever it takes to make every visit to our office a pleasant, relaxed experience. With all of the important Information about our practice available on our website, you can feel confident that you and your child are well-prepared for your first appointment. We also invite you to review our staff page in order to get to know our doctors and staff. We look forward to meeting you.

Our Mission

When people think of a visit to the pediatrician, almost always the thought is of “shots”. Clearly giving vaccines is a very important thing we pediatricians do, but it is not nearly the only one. Being a pediatrician gives us the unique opportunity to make a positive long lasting impact in the life of our patients.

We believe in a good beginning is essential for a lifetime of health and well being. This is more true as we face great threats to our health and the health of our children:

  • 3 out of 10 children are overweight or obese (this is worse in Hispanics).
  • 1-2 out of 10 children have developmental or behavioral problems
  • About 1 in 160 children have autism. Early identification and management in this condition is critical to prevent a lifetime of impairment and suffering for the child and the family.
  • In the school age children, they increasingly face barriers to their learning and growth: Attention Deficit Disorder (ADHD) and Learning Disabilities.
  • 2 out of 10 children have criteria for mental health disorder
  • At least half adults with mental health disorders had symptoms by the age of 14 years
  • Yet only 20% of children with mental health problems and substance abuse receive services

That said, we strive to provide services in the area of developmental-behavioral and mental health as well as nutrition to ensure our patients have the best possible outcome given the particular situation in which they are. For this we have restructured and enhanced the traditional well child visit to proactively identify as early as possible, intervene and modify risk factors, prevent bad outcomes and manage or refer when appropriate.

We do this by implementing ongoing surveillance and periodic formal screening. We also have developed expertise in managing the most basic of these problems and developed a network of referral providers to refer when the situation requires.

Patient Forms

We are happy to provide our office forms for convenient download on your home computer. Please print and complete the forms below, and bring them with you to your child's first appointment. Questions about which forms you need? Please call our office and our courteous staff will assist you in preparing for your child's first visit.

English

En Español

Surveys and Questionnaires

We are happy to provide the surveys/questionnaires used during our visits for convenient download on your home computer. Please print and complete the forms below, and bring them with you to your child's well visit/obesity follow-up/ADD appointment. Questions about which forms you need? Please call our office and our courteous staff will assist you in preparing for your child's visit.

English

En Español

The Initial Visit

Our compassionate city pediatricians do whatever it takes to make every visit to our office a pleasant, relaxed experience. With all of the important information about our practice available on our website, you can feel confident that you and child are well-prepared for your first appointment. We also invite you to review our staff page in order to get to know our doctors and staff. We look forward to meeting you.

Our Locations

Find us on the map

Hours of Operation

*LUNCH: 1-2PM Everyday

Addison Office

Monday:

9:00 am-6:00 pm

Tuesday:

9:00 am-6:00 pm

Wednesday:

9:00 am-5:00 pm

Thursday:

9:00 am-6:00 pm

Friday:

9:00 am-1:00 pm

Every Other

Saturday:

9:00 am-1:00 pm

Sunday:

Closed

Brookfield Office

Monday:

9:00 am-6:00 pm

Tuesday:

11:00 am-6:00 pm

Wednesday:

9:30 am-5:00 pm

Thursday:

9:00 am-6:00 pm

Friday:

9:00 am-1:00 pm

Every Other

Saturday:

9:00 am-1:00 pm

Sunday:

Closed