Forms

ADHD Parent Follow Up (PDF)

ADHD Teacher Follow Up (PDF)

Behavioral Health Coordination of Care Consent (PDF)

Consent to Treat: Unaccompanied Minor (older teen)

Allows an older teen, who may have driven themselves to our office, to seek care without a parent present

Consent to Treat: Authorization for a non-parent

Allows grandparents, relatives and caretakers to seek care with a patient in our office on behalf of the parent

Young Adult Consent: Allowing Proxy Access

Young Adult grants parental access to some/all records and/or ability to communicate with our office on their behalf

Behavioral Health Coordination of Care Consent

Allows Pediatrician and Mental Health Provider to communicate

New Patient Past Medical History

Transfer In Form

Consent for transfer of records from previous provider

DemographicTransfer Form

Transfer In Form

Transfer Out Form