Pediatic Health History

For your convenience, ARC provides access to forms online. You can print these forms and fill them out at your convenience. Please bring the appropriate form with you to your appointment. You will need Adobe Reader to view and print these forms. If you do not have it you can download it for free from Adobe. Click on the link below.

Please use the forms below if you are a new patient to Austin Regional Clinic.

New Pediatric Patient History
New Adolescent Patient History

Please use the forms below if you are an established patient with Austin Regional Clinic.

Well-Child Check Questionnaire
Adolescent Well-Child Check Questionnaire

Information concerning treatment after vaccinations.

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