Read, complete and sign our Patient Agreement Form

Authorize the release to Zanesville Pediatrics, my medical history, laboratory reports, x-rays and any other material regarding medical consultations and treatments received.

Use this link if you are a current patient of Zanesville Pediatrics and want to update contact details and address information.

Updates for patient information are made online via our patient portal.

- Login to Patient Portal
- Locate "My Account" menu link on left hand side of the screen
- Select "Personal Information" and update all relevant fields
- Additional updates can be provided via the "Additional Information" link
- Your response will be securely stored in your patient records.
Open Patient Portal

Please complete this form as thoroughly as possible describing you for the past 7 days.

This form should be completed online via our Patient Portal. Please follow these steps to locate this form:

- Login to Patient Portal
- Locate "Questionnaires" menu link on left hand side of the screen
- Expand "Questionnaires" and click on "Medical History"
- Along the top of the page locate "Depression Form" and complete the form accurately
- Your response will be securely stored in your patient records.
Open Patient Portal

Each rating should be consisdered in the context of what is appropriate for the age of your child. Please think about your child's behavior in the last 3 months.

This form should be completed online via our Patient Portal. Please follow these steps to locate this form:

- Login to Patient Portal
- Locate "Questionnaires" menu link on left hand side of the screen
- Expand "Questionnaires" and click on "Medical History"
- Along the top of the page locate "ADHD Parent Questionnaire" and complete the form accurately
- Your response will be securely stored in your patient records.
Open Patient Portal

Each rating should be considered in the context of what is appropriate for the age of the child. Please think about the child's behavior in the last 3 months.

This form should be completed online.

Open Form

The PHQ-9 is a multi-purpose instrument for screening, diagnosing, monitoring and measuring the severity of depression.

This form should be completed online via our Patient Portal. Please follow these steps to locate this form:

- Login to Patient Portal
- Locate "Questionnaires" menu link on left hand side of the screen
- Expand "Questionnaires" and click on "Medical History"
- Along the top of the page locate "Patient Health History 12 yrs" and complete the form accurately
- Your response will be securely stored in your patient records.
Open Patient Portal