New Patient Forms for 17 & Under

New Patient for 17 & Under, please complete the following forms: New Patient Information, HIPPA notice and two HIPPA releases (one for insurance and one for your primary care physician). Please select the checklists for depression, anxiety, and ADHD that correspond to the patient’s age.

New Patient Information HIPPA Notice Primary Doctor Information Insurance Company Information Therapy Patients’ Bill Of Rights Burns Inventory Checklist ADHD Self-Report Scale Symptom Checklist Telemedicine Informed Consent Form