Early Childhood Screening Forms

When you make an appointment for Early Childhood Screening, you will receive an email with links to online forms you will need to complete. As an alternative, you can download and print the necessary forms here. Please contact our office with any questions at 763-792-6120.

Required Forms (will be sent to you before your appointment)

Screening Registration Form

Screening Consent Form

Child Health and Developmental History Form

Release of Information Form

If you wish to waive the early childhood screening requirement for your child, you can complete a conscientious objector form. Please submit to the Early Childhood office. 

Conscientious Objector/Waiver Form

If you choose to have your child screened at the doctor/clinic, please have your physician complete the following form and return to the Early Childhood office. 

Early Childhood Screening Summary Form - For Doctor