ARE YOU NEW TO THE PRACTICE? DO YOU NEED TO MAKE UPDATES TO RECENT CHANGES?
The forms listed below allow our clients to complete initial paperwork or provide updates on any changes.
The links will direct you to our HIPAA protected forms.
Please enter your name and email address to open the HIPAA protected form(s) selected.
Completing the forms timely will avoid any delays, improper billing or pharmacy submissions, and allow you to have more concentrated time with your provider.
CLICK ON THE SECTIONS BELOW FOR FORMS
TRADITIONAL TREATMENT FORMS:
NEW CLIENT INTAKE FORMS (Psychiatric/Psychotherapy)
NEW COACHING INTAKE FORMS (Wellness Coaching)
UPDATE CLIENT FORMS (2023 Update forms)
HIPAA/BILLING AUTHORIZATION FORM
CREDIT CARD AUTHORIZATION FORM
MEDICATION PHARMACY UPDATE FORM
PARENT-CHILD UPDATE FORM (Parent-Provider Communication)
ASSESSMENT TOOLS AND BEHAVIORAL SCALES
VANDERBILT ADHD SCALE (Parent) – INITIAL
VANDERBILT ADHD SCALES (Parent) – FOLLOW UP
VANDERBILT ADHD SCALES (Teacher)—INITIAL
VANDERBILT ADHD SCALES—(Teacher) FOLLOW-UP
COORDINATION OF CARE (Authorizes Communication between Providers)
RELEASE OF INFORMATION FORM (Authorizes Communication with others)
Medication Side Effects
ANTIOLYTICS (FOR ANXIETY)