Forms

When you call the office, you’ll get my voicemail.¬† I schedule all appointments myself and this allows me to schedule the appropriate type of consultation or evaluation for you. Please leave a voicemail message with a brief description of why you want to consult with me along with a phone number and a good time to call you. I return messages¬†7 days a week.

When you schedule your appointment, I’ll advise which forms your should print out, complete and and bring to your appointment.

Consultation for child under age 18:

  1. Child Registration Form
  2. HIPAA-Notice & Acknowledgement of Receipt of Privacy Practices
  3. Office Policies & Consent to Treatment

Consultation for Adult

  1. Adult Registration Form
  2. HIPAA-Notice & Acknowledgement of Receipt of Privacy Practices
  3. Office Policies & Consent to Treatment

Evaluation for Gifted Eligibility

  1. Child Registration Form

Evaluation for Learning Disability, Educational/Test Accommodations for Learning Disability or Attention Deficit Disorder

  1. Child Registration Form
  2. Adult Registration Form
  3. HIPAA-Notice & Acknowledgement of Receipt of Privacy Practices
  4. Office Policies & Consent to Treatment
  5. Childhood History Form

Evaluation for Developmental Disorder

  1. Child Registration Form
  2. Childhood History Form
  3. HIPAA-Notice & Acknowledgement of Receipt of Privacy Practices
  4. Office Policies & Consent to Treatment