Forms

Adult Patients (Ages 21+)
Adult patients please complete the following forms before your first appointment.

Adult Registration Information
Credit Card Authorization Form
Adult Medical History
Office Policy
HIPAA
Consent for Email Communication
Consent for Telemedicine
Appointment Reminder Authorization
Adult DSM Symptom Questionnaire

Adolescent Patient (Ages 8-20)
If you are a parent or guardian bringing your child for an evaluation please complete the following forms before your first appointment.

Child/Adolescent Registration Information
Credit Card Authorization Form
Guarantor Agreement
Child and Adolescent History
HIPAA
Age 6-11 DSM Symptom Questionnaire
Age 11-17 DSM Symptom Questionnaire
Consent for Email Communication
Consent for Telemedicine
Appointment Reminder Authorization

Other Forms

ADHD Side Effect Checklist
ADHD Symptom Checklist
Consent For Release of Information

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