Pediatric Neurodevelopmental Clinic Intake Form

Streamline Pediatric Neurodevelopmental Assessments with Paperform

Getting accurate, comprehensive information from parents and caregivers is the foundation of quality pediatric neurodevelopmental care. Whether you're screening for autism spectrum disorder, evaluating ADHD symptoms, assessing learning disabilities, or coordinating early intervention services, the initial intake process sets the tone for the entire patient journey.

This Pediatric Neurodevelopmental Clinic Intake Form template is designed specifically for developmental pediatricians, child psychologists, neuropsychologists, occupational therapists, and multidisciplinary clinics that serve children with neurodevelopmental differences. It replaces lengthy paper packets with a modern, mobile-friendly digital experience that families can complete at their convenience—before they even arrive at your clinic.

Why Healthcare Providers Trust Paperform for Patient Intake

Paperform is built for healthcare practices that need secure, compliant, and professional forms without the complexity of traditional medical software. While Paperform is not HIPAA compliant and should not be used for protected health information (PHI) in regulated healthcare settings, it excels at collecting non-PHI registration and intake information for private practices, wellness clinics, and healthcare organizations with flexible compliance needs.

This template collects essential demographic information, developmental history, behavioral observations, family medical history, and insurance details—all the foundational data you need to prepare for a thorough evaluation. The form uses conditional logic to reveal relevant follow-up questions based on parent responses, creating a personalized experience that doesn't overwhelm families with unnecessary questions.

What Makes This Template Powerful

Comprehensive developmental screening: The form includes evidence-based screening questions adapted from standardized tools like the M-CHAT (Modified Checklist for Autism in Toddlers), ADHD rating scales, and developmental milestone checklists. Parents can provide detailed information about their child's communication skills, social interactions, repetitive behaviors, attention span, hyperactivity, sensory sensitivities, and learning challenges.

Smart conditional logic: If a parent indicates concerns about autism, specific ASD screening questions appear. If they report attention difficulties, ADHD-focused questions are revealed. This intelligent branching creates a streamlined experience while ensuring you gather all the clinical information you need for differential diagnosis.

Family-friendly design: Using Paperform's document-style editor, the form is organized into clear sections with helpful context for parents. You can add your clinic's branding, warm welcome messages, and even videos explaining the intake process—all without touching code.

Seamless clinical workflows: Once submitted, this intake information can automatically flow into your practice management system, trigger appointment confirmation emails, create tasks for your administrative team, or generate summary reports for clinicians. Using Stepper, Paperform's AI-native workflow builder, you can automate the entire pre-visit process: sending intake forms at the right time, following up on incomplete submissions, routing completed forms to the appropriate specialist, and preparing clinical summaries before the first appointment.

Who This Template Serves

This intake form is ideal for:

• Developmental pediatricians conducting comprehensive neurodevelopmental evaluations
• Child psychologists and neuropsychologists offering autism, ADHD, and learning disability assessments
• Multidisciplinary neurodevelopmental clinics coordinating care across specialties
• Early intervention programs screening children for developmental delays
• Occupational and speech therapists gathering background before therapy evaluations
• School psychologists and educational consultants working with families privately

Customize for Your Clinical Practice

Every neurodevelopmental practice has unique protocols, assessment tools, and intake requirements. This template provides a professional foundation you can tailor to your approach:

• Adjust screening questions to match your preferred assessment instruments
• Add intake questions specific to your therapeutic modalities or intervention programs
• Include consent language for developmental testing, video recording, or research participation
• Customize insurance and billing sections for your payment structure
• Brand the form with your clinic colors, logo, and welcoming imagery

Beyond Intake: Building Connected Care Experiences

The intake form is just the beginning. Paperform helps neurodevelopmental practices create connected digital experiences throughout the patient journey:

• Send progress monitoring forms to parents between visits to track developmental changes
• Collect teacher rating scales for ADHD evaluations without paper forms
• Share post-evaluation surveys to gather feedback on your assessment process
• Use Papersign to send treatment consent forms, IEP coordination agreements, or medication consent forms for secure electronic signature
• Create parent education resource libraries with conditional content based on their child's specific diagnosis

With Paperform's conditional logic, you can even create dynamic care pathways—families screening positive for autism receive different follow-up communications than those with ADHD presentations, ensuring personalized guidance from the first touchpoint.

Data Security for Healthcare Settings

Pediatric neurodevelopmental information is sensitive, and families trust you to protect it. Paperform offers enterprise-grade security features including SSL encryption, SOC 2 Type II compliance, data residency controls, and robust access permissions. For practices requiring full HIPAA compliance, review Paperform's documentation to ensure alignment with your regulatory obligations, or use this template for non-PHI intake data only.

Get Started in Minutes

This template is ready to use immediately—just customize the questions for your practice, add your branding, and share the link with families. New patient intake that once took 30 minutes in your waiting room can now be completed on parents' own time, arriving at your practice organized, complete, and ready for clinical review.

Trusted by healthcare providers worldwide and featuring SOC 2 Type II compliance, Paperform transforms the pediatric intake experience from administrative burden to clinical asset. Start with this template and discover how digital forms can improve both family satisfaction and clinical efficiency in your neurodevelopmental practice.