637 Washington Street • Suite 202 • Brookline MA 02446

(617) 232-2811

(617) 383-8178


Forms & Resources

In this section you will find information about specific medical advice for basic problems, information about your child’s well visit form, and miscellaneous forms that you might need to download and print.

Medical Information

The following are forms regarding medical care. This information does not replace actual medical advice as given by a professional and is not specific to any one child or any one medical situation.


Vomiting or Diarrhea

How to Prevent Stomach Bugs

Dosing for over-the-counter medications

Includes Tylenol (Acetaminophen), Advil/Motrin (Ibuprofen), and Benadryl (Diphenhydramine)

ADHD Diagnostic Checklist

Toilet Training

Starting Solids

Parent Feeding Styles

How to do your Strep Test at home (video)

Well Visit Forms

At the completion of your child’s routine annual check up, you will receive a general health form which will include up-to-date immunization information. This form can be used for school, camp or sports registration, or proof of health for jobs for teens. Please keep the form you receive in a safe place and make copies to provide to school, camps, or other institutions. We highly recommend that you take a picture of this form on your phone so you have access to this form at all times.

If you need additional forms completed by your physician, fill in as much of the form as you are able and submit them either in person, or in a self addressed, stamped envelope and allow 5-7 business days for completion.

There is a charge to provide you with extra copies of your child’s health form.

New Patient Information

Family History Form

General Consent Form

Notice of Privacy Practices

Adolescent Consent to Share Medical Information with Guardian or Parent

Vaccine Information Sheets

  • Your Child's First Vaccines
  • Hepatitis B
  • Haemophilus influenzae type b (Hib)
  • PCV
  • Polio
  • Rotavirus
  • DTaP
  • Hepatitis A
  • Varicella (chickenpox)
  • MMR
  • HPV
  • Tdap
  • Meningococcal ACWY
  • Td
  • Flu
  • Website Design © 2023 James Little

    Content © 2023 Sally Roth, Sari Rotter, Susan Laster, Magdalena Ivanova

    Photos by Sari Rotter & Bill Gardner


    Drs. Roth, Rotter, Laster and Ivanova are preferred Boston Children's Hospital Community of Care members.