Forms

​​NEW PATIENTS 
Please complete and bring the forms with you to your first appointment
• Patient Registration form
• Authorization to Release Medical Information

• Consent form 

Your privacy is important to us. Please read our Notice of Privacy Practices for our office.

EXISTING PATIENTS FORMS
Please assist us in assuring continuity of care for your child by updating us with any changes in your personal and family information. To save time at your appointment, please complete these forms as needed and bring to your next appointment.

• Patient Registration form (complete one per child please)
• Insurance Update Only
• Authorization to Release Medical Information


Moving or need information transferred to another provider for continuity of care.
Please complete and submit this Authorization form to the appropriate office.


OTHER FORMS
For your convenience, here are links for other forms to complete if your school or doctor has requested you to do so.
• Authorization for Administration of Medication at School (your school or daycare may have their own form)

ADHD Initial Parent Questionnaire
ADHD Initial Teacher Questionnaire
ADHD Parent Follow-up Evaluation
ADHD Teacher Follow-up Evaluation

ADHD Medication Refill request form (please mail, fax, or drop off in ADVANCE of anticipated need)

Download Form
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ADHD Medication Refill ​
ADHD Initial Parent Questionnaire
ADHD Initial Teacher Questionnaire
ADHD Parent Follow-up Evaluation
ADHD Teacher Follow-up Evaluation
Privacy Practices
Patient Registration
Insurance Update
Medication School
Consent