Patient Forms

• Authorization for Release of Medical Information (PDF) Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.
• Authorization and Consent for Treatment (PDF) — All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. Autorización y Consentimiento Para el Tratamiento.
• Preferred Contacts (PDF) — Patients are encouraged to complete and return the Preferred Contacts Form but it is not required. Contactos Preferidos

Pediatric Forms

ADHD Assessment

• Parent Initial
• Parent Follow-Up
• Teacher Initial
• Teacher Follow-Up

Screenings

• Asthma Screening
• Depression Screening
• Anxiety Screening
• Post-Partum Screening
• 18 Month/2 Year Well-Check with Autism Screening

HEADDS Questionaire

Male

• Ages 11–13
• Ages 14 and Up

Female

• Ages 11–13
• Ages 14 and Up