FormsIn this section you can find many of the common forms we use in the clinic to gather health information about your child. You may download and print this forms, complete them and submit them in person, by fax (762-3389) or by mail. New Patient Forms
Demographics
Fill this form out if your child is new to our practice. This form provides us with basic information about your child, your contact information, and your insurance. By signing this form you will be giving us permission to treat your child.
Medical History
New patients will also need to complete this form. This gives us a snapshot of your child's medical history. Bring this form and the Demographics form with you to your first appointment.
Privacy Policy
Click on this form to download a copy of our privacy policy. We take the privacy of your personal and medical information very seriously.
ADHD Forms- ADHD Evaluation: This form is used to gather information about children who are suspected of having ADHD or behavioral health problems. Both parent and teacher forms should be completed prior to the child's first appointment.
- Parent ADHD Follow-up: This form is for established patients with ADHD. The parent form should be completed prior to every ADHD recheck and any other time you would like to give us some feedback about how your child is doing. The teacher form should be completed upon request by us or any time they desire to give us feedback on the child's classroom performance.
Pediatric Symptom Checklist (PSC)
Pediatric Symptom Checklist (PSC)
This form is used to help us identify children at risk for a wide range of mental health concerns. It can be completed by a parent of any child 6 years and older as a screening tool to detect problems with mental processing, behavior or emotions.
| 
