New Patient Information
If your child is scheduled for an evaluation, please download, fill out, and sign the following forms and either email them back to firstname.lastname@example.org or bring them to your first appointment. This will expedite the registration process. Please be sure to contact us should you have any questions about the forms.
Intial Evaluation Check List
- HIPPA Provider Notice of Privacy Practices(Maintain for your records)
- New Patient Orientation Policy (Completed and Signed)
- Patient Medical History & Questionnaire(Completed)
- Insurance Card (front and back photo copy emailed to email@example.com or provided at the evaluation)
Our forms are PDF files. To download and print the forms, you’ll need the free Adobe Acrobat Reader program.