Forms

Intake Forms

New Patient Packet

This file contains forms needed for your initial consultation. Please read and complete them prior to your visit.

HIPAA Privacy Notice

Our Privacy Policy

Office Policy

Although contained in our new patient packet, the office policy is available separately for your convenience. Please read it carefully.

Payment Authorization Form

Use this form for remote payment.

HIPAA Authorization for Release of Information

These forms are required for us to release any clinical information.

Clinical Questionnaires

Attention Report

A brief self-assessment scale useful in tracking symptoms related to attention and concentration.

Mood Monitor

A useful log to track mood symptoms over the course of a month.

Attention Report (Parents & Teachers)

A brief scale useful in tracking symptoms related to attention and concentration.

Sleep Monitor

This log helps chart out sleeping patterns and how they may respond to various interventions.