Forms – Community Bridge Clinic

If you have questions about a form, need assistance filling it out, or would like to schedule an appointment for services, please call us at 860-437-4550.
Asthma Control Test – ages 4-11
Asthma Control Test – ages 12+
Bright Futures Physical – age 3
Bright Futures Physical – age 4
Bright Futures Physical – age 5
Bright Futures Physical – age 6
Bright Futures Physical – ages 7-8
Bright Futures Physical – ages 9-10
Bright Futures Physical – ages 11-14
Bright Futures Physical – ages 15-17
Bright Futures Physical – age 18+
Child Enrollment / Intake
Columbia Teen (11 years old +) – to be completed by teen
Columbia Teen (11 years old +) – to be completed by parent
Consent to Vaccination
CRAFFT+N Questionnaire
Adult Enrollment / Intake
Flu Vaccine Consent
COVID-19 Consent
Health Assessment Record
PHQ-9
PSC (Pediatric Symptom Checklist) Parent
Review of Systems
Sports physical evaluation
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