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Award-winning Pediatric and Adolescent care from ages 0-24 years of age. Open 365 days per year to suit your family’s medical needs.

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Forms

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List of forms available to download and complete prior to visit.

New Patient Forms

  • New Patient Packet

Demographic Forms

  • Under 18 years Demographic
  • Over 18 years Demographic

General Forms

  • Medical History
  • General Consent (Under 18 Years)
  • General Consent (Over 18 Years)
  • New Patient Survey
  • CTMC Notice of Privacy Practices
  • CTMC Price Transparency
  • Consent for minor without parent
  • Sports Physical Form
  • Community Resources

Release of Information Forms

  • Release of Information from CTMC
  • Release of Information to CTMC

Well-Child Forms/Info

  • Maternal Depression Survey 
    (Birth-6 months)
  • Mental Health Survey
    (ages 12 years and up)
  • Developmental Screening for Well-Child Visits
    (1 month -5 years)
  • Immunization/Vaccine schedule

Asthma Forms

  • Childhood Asthma Control Test (C-ACT)
    (ages 4-11 years)
  • Asthma Control Test (ACT)
    (ages 12 years and up)

ADD/ADHD/Behavioral Visits

  • Vanderbilt Parent Initial Form
  • Vanderbilt Parent Follow-up Form
  • Vanderbilt Teacher Initial Form
  • Vanderbilt Teacher Follow-up Form
  • Mental Health Survey

Depression/Anxiety Visits

  • Mental Health Survey
Love...Kindness...and Excellence.

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Contact Us & Appointments

  • Patient Portal
  • Free Baby Classes
  • Appointment

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BLAINE

Monday-Thursday
7:30 am-7:00 pm
Fridays
7:30 am-5:00 pm
Weekends and holidays
9am-10:30am walk-in

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FRIDLEY

Monday-Friday
7:30 am-5:00 pm

Map it | Get Directions  

Love...Kindness...and Excellence.

© 2023 Child & Teen Medical Center. All rights reserved.
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Contact Us:

763-333-7733

Call us Anytime
24-hour on-call service

Walk-in urgent care

Weekends and Holidays 9 am -10:30 am at our Blaine location only.
Patients can arrive as early as 8:45 am

Hours

Business office hours: 7:30-4:30,
Nurse Triage: 8-4:30,
Office Administration: 8-5