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  1. Home
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  3. Patient Forms
  4. Page Updated: October 7, 2017

Patient Forms

Fill out and submit forms as needed or directed by clinic staff.

Download or Print Forms Below

Demographics Form

Developmental Screening Forms

Developmental Screening (2 Months)

Developmental Screening (4 Months)

Developmental Screening (6 Months)

Developmental Screening (8 Months)

Developmental Screening (9 Months)

Developmental Screening (10 Months)

Developmental Screening (12 Months)

Developmental Screening (14 Months)

Developmental Screening (16 Months)

Developmental Screening (18 Months)

Developmental Screening (20 Months)

Developmental Screening (22 Months)

Developmental Screening (24 Months)

Developmental Screening (27 Months)

Developmental Screening (30 Months)

Developmental Screening (33 Months)

Developmental Screening (36 Months)

Developmental Screening (42 Months)

Developmental Screening (48 Months)

Developmental Screening (54 Months)

Developmental Screening (60 Months)

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Cross Road Health Ministries, Inc. is deemed (approved) under the Federal Tort Claims Act (FTCA) for medical malpractice liability protection for activities that are under the approved scope of the Health Resources and Services Administration 330 grant. Under federal law relating to the operation of health centers, the FTCA provides the exclusive remedy for damage from personal injury, including death, resulting from the performance of approved employees, eligible contractors and volunteers in approved medical, surgical or related functions of the clinics and pharmacies of Cross Road Health Ministries, Inc. [Health Center Program grantee under 42 U.S.C. 254b, and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n), Public Health Service Act subsection 224(q), codified at 42 U.S.C. 233(q)]..

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