|
Helpful Forms All forms are available in Adobe Acrobat (.pdf) format You can download the Adobe Acrobat reader free HERE
Visiting us for the first time? To find out more about our practice, please contact us via email.
We like to give you every opportunity to recall important details of your past history. Completing paperwork in advance will always help to make your appointment as efficient as possible. All information submitted is confidential.
INITIAL EVALUATION PACKET
Please email us to obtain the initial evaluation packet
RELEASE OF INFORMATION FORM (please complete and bring to initial appointment if you authorize us to contact any of your past treating clinicians) Release of Information (1 page)
WHAT THE GOVERNMENT REQUIRES YOU TO KNOW ABOUT YOUR HEALTH INFORMATION Our Privacy Practices (3 pages) "Our Privacy Practices" Acknowledgement (1 page)
FINANCIAL FORMS
CLINICAL & INFORMATIONAL FORMS FORMS FOR CHILDREN/ADOLESCENTS ADHD & ODD (SNAP scale) (2 pages) Parents and/or Teachers to complete Child and Adolescent Psychiatry Screen (3 pages) Parents and/or Teachers to complete Child Mania Rating Scale (3 pages) Parent to Complete (for Bipolar diagnosis) Depression Scale (CES-DC) (2 pages) Child to complete (Center for Epidemiological Studies) Child and Adolescent Anxiety Screen (3 pages) Child to complete (S.C.A.R.E.D. questionairre) GROWTH CHARTS Growth Chart, Boys Ages 2-20 (1 page) Growth Chart, Girls Ages 2-20 (1 page)
FORMS FOR ADULTS Adult ADHD Rating Scale (1 page)
(World Health Organization Screening Tool) (Center for Epidemiological Studies Scale)
|
|
Terms of Use for this Website
Family
Therapeutics Brochure |