Forms

Note: Downloadable forms on this page are currently inaccessible.

This area will be repaired in the near future – please check back shortly.

On occasion, we ask our patients to complete some questionnaires before an initial visit or before a follow-up visit. We have gathered some of our more common forms here. Some forms (downloadable forms) can be downloaded and filled in on your computer. They can then be submitted to us online. Others (simple forms) must be printed and filled out by hand. If you have difficulty printing the forms, let us know and we will mail you a copy.

Please note that questionnaires will not be reviewed until the time of your next appointment. Prior to submitting information to us electronically, please review the terms for the use of electronic communication with the office.

Ages and Stages. Click here to access our dedicated Ages and Stages web site. Follow the instructions on screen. Once completed, the results are transmitted directly to the clinic.

Child Behaviour Checklist or Youth Symptom Report. If you have been given a special access code in order to complete a CBCL or YSR, or if you are a teacher who has been given an access code to complete a teacher report, click here. You will be taken to the secure ASEBA site, which maintains the questionnaires. Simply enter your access code in the appropriate spot, and follow the instructions on the screen.

Downloadable Office Forms. We have converted our common office forms to electronic format. Click here to access forms. Choose the appropriate form, complete it on your computer, press the “Submit” button, and the results come automatically to the clinic. Sorry, these forms don’t work on many tablets and phones.

Simple forms. For those who prefer a paper format (and have access to a printer), click here. Forms can be printed, filled out by hand, and brought to the office.

Request WebMail Access: For current patients of Dr. Johnston or Jill Nooyen, click the download button to request access to our secure webmail system. This will allow you to contact us electronically for simple administrative issues such as making or cancelling appointments. Be sure to review the terms for the use of electronic communication with the office.