Patient Forms

Forms can be completed online through the patient portal or you can print them from our website and bring them with you to your appointment.


ADHD / ADD appointment information –

The physicians at North Dallas Pediatric Associates requires that your child be seen in the office every three months; once a year for a physical exam and three times a year for an ADHD/ADD follow-up evaluation.

In addition to the examination by the doctor, ADHD/ADD evaluations depend in part on feedback from the parent and the child’s teachers.

The documents shown below are used during these evaluations.

Effective June 1, 2015, all ADD/ADHD medication refill requests will require 5 business days to process (do not count Saturday and Sunday).

If you insist on a prescription being processed in less than that amount of time, you are subject to a $25.00 service charge, payable at the time of pick-up in the Plano office.

If you lose a prescription, let it expire, or do not receive it in the mail, you must pick up a new prescription in the Plano office and pay the $25.00 fee as well.

You can avoid these situations by doing the following:

  1. Book your appointment before you leave the office. Anyone in the office can do this for you. If you do not have an appointment scheduled, your refill request will be denied.
  2. Request your refill online (not by phone). If you require a reply, we will not call you. You will receive a reply via email. Make sure to check your junk mail if you have not made us a “safe” contact.
  3. If you choose to call for a refill and do not have your next appointment scheduled, you will receive a letter which will delay the process even more.

We are trying to make this process as smooth as possible.

Thank you in advance for your cooperation.

North Dallas Pediatrics

Kids Corner

Online Kids Games, Preschool Crafts and Family Activities.

Play, explore, and read on PBS KIDS Island

Top 100 Children’s Books



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What’s New

As part of your Well Care, and under the guidelines of Bright Futures and the American Academy of Pediatrics, your doctors has asked that you complete the Nutrition Questionnaire. You can find the appropriate age form for your child below.

Optimal nutrition is important for sustenance, good health, and well-being throughout life. As the relationships among diet, health, and disease prevention have become clearer, nutrition and the promotion of healthy eating behaivors have received increased attention. The nutrition status of infants, children, and adolescents affects their growth and development and resistance to diseases. Lifelong eating behaviors and physical activity patterns are often established in early childhood. Therefore, it is important for children and adolescents to build the foundation for good health by choosing a healthy lifestyle, including practicing healthy eating behaviors and participating in regular physical activity.


Dr. Allan deVilleneuve, Dr. Carolyn Evans, & Connie Ray RN, CPNP

Related Documents:

Nutrition, Children 1yr – 10yr
Nutrition, Adolescents 11yr – 21yr