SERVING CHILDREN WITH
SPECIAL NEEDS & THEIR FAMILIES
Since 1950
physician referral

New Patients

Thank you for choosing Siskin Center for Developmental Pediatrics to provide specialized care for your child. We are committed to helping your child reach their maximum potential. 

Your initial appointment with our team is a comprehensive visit which typically lasts 90 minutes. To help us evaluate your child, we need to understand as much as possible about your their history and development therefore we ask that parents or caregivers please complete the following forms prior to arriving for your scheduled appointment. Please note-  The following forms require Adobe or Adobe Reader to access as well as a computer to complete and save documents. Access via cellphones and tablets may not work correctly. 

For initial medical appointments please complete all sections of the New Patient Developmental History Form. This form can be downloaded to your computer using Adobe. (Click here for instructions on how to download, save, and electronically return forms to us). Forms may also be faxed to 423-490-7750. Additionally, if your child is over three years old and in a preschool/school, please have your child's teacher complete the school report and the Vanderbilt Assessment.

For a new therapy appointment please complete all applicable section of the New Patient Therapy History Forms. This form can be downloaded to your computer using Adobe. (Click here for instructions on how to download, save, and electronically return forms to us).Forms may also be faxed to 423-490-7750.

In an effort to accommodate all patients who require services we ask that you read the following:

Initial paperwork required prior to first visit:
We must receive required forms above at least 48 hours prior to your child's appointment to hold your child's appointment. If you need to reschedule your appointment please call 423-490-7710. We require 48 hours' notice to cancel an appointment. Additionally we MUST confirm all appointments within 48 hours of scheduled time. All unconfirmed appointments will be canceled and rescheduled. Due to the high volume of referrals, rescheduling may result in a 4 to 6 month wait for another appointment.

Legal Guardianship: Under Tennessee Law we are required to obtain court documents indicating the legal guardian of a child NOT accompanied by a biological (birth) parent. Please click here for our Proof of Guardianship policy and be certain to provide the requested court documents so that we can provide care for your child.

Office Policy: We value our relationship with you and believe effective communication is an important part of making your experience with the center a positive one. For this reason we ask that you read our Office Policy by clicking here. These guidelines include information such as what to bring to your visit, prescription refills and scheduling appointments. You will be asked to sign a statement that you have read and agree to these policies at check in.

Additionally, for your convenience we offer a patient portal on our website. This portal is a convenient way to update information, view future appointments, request prescription refills (with advance notice), view and pay bills and other options.

In summary you should download, save, complete and return to us:

New patient developmental history form (for new medical appointments)
School Report (for a new medical appointments for children over 3 years of age and in school)
Vanderbilt Assessment (for a new medical appointments for children over 3 years of age and in school)

New patient therapy history forms (for OT, PT or speech therapy evaluations)

Click here for Instructions on how to send forms to Siskin Children's Institute.

These completed forms are required to perform our evaluation on the day of your child's appointment and will become part of your child's medical record. Please return these form at least 48 hours prior to your child's appointment.

For more information on what to expect at your child's appointment and after the appointment, click here.

Thank you again for choosing our Siskin Center for Developmental Pediatrics to serve your family.