Forms & Policies

• Patient Contact Information (PDF)
• Financial Policy Patient Copy (PDF)
• HIPAA Form (PDF)

• Authorized School Medication Form (PDF)
• Change of Demographics Form (PDF)
• Release of Medical Records TO Us (PDF)
• Release of Medical Records FROM Us (PDF)
• Unaccompanied Consent (PDF)
• Unaccompanied Consent Signature Form (PDF)

• ADHD Initial Evaluation Packet (PDF)
• ADHD Follow-Up School Age (PDF)
• ADHD Follow-Up Middle High School (PDF)

Early Childhood Development Screening

• Edinburgh Scale
• ASQ 3-2 Mo Set B
• ASQ 3-4 Mo Set B
• ASQ 3-6 Mo Set B
• ASQ 3-9 Mo Set B
• ASQ 3-12 Mo Set B
• ASQ 3 16 Mo Set B
• ASQ 3-18 Mo Set B
• ASQ 3-24 Mo Set B
• ASQ 3-36 Mo Set B
• ASQ 3-48 Mo Set B
• ASQ 3-60 Mo Set B
• MCHAT-R

School Age/Adolescent Development Screening

• Early Adolescent Survey
• Adolescent Survey
• Parent of a School Age Child
• Parent of a Teenager Health Questionnaire, Age 12-18
• PHQ-9
• SCARED Child Form
• SCARED Parent Form