Forms

Forms

Please select the tab that best represents your age range to see the necessary forms. Click on the form name to view and print the document. 

These forms must be filled out and brought in to your first visit.

Child History Questionnaire

Rating Scale for General Symptoms Questionnaire

Rating Scale for Home Behavior Questionnaire

*Please note: Each parent should complete this form separately

Learning Disability Questionnaire

New patient information form

Notice of Psychologists’ Policies and Practices to Protect the Privacy of Your Health Information

General information on our standard procedures

Credit card authorization form

Child History Questionnaire

*Please note: Parent to complete this form

Teen History Questionnaire

*Please note: Teen to complete this form

Rating Scale for General Symptoms Questionnaire

*Please note: Both teen and parent to complete this form

Rating Scale for Home Behavior Questionnaire

*Please note: Each parent should complete this form separately

Learning Disability Questionnaire

New patient information form

Notice of Psychologists’ Policies and Practices to Protect the Privacy of Your Health Information

General information on our standard procedures

Credit card authorization form

Young Adult History Questionnaire

*Please note: Young adult to complete this form

Rating Scale for Adult ADHD Type Questionnaire

Rating Scale for General Symptoms Questionnaire

Learning Disability Questionnaire

New patient information form

Notice of Psychologists’ Policies and Practices to Protect the Privacy of Your Health Information

General information on our standard procedures

Credit card authorization form

Rating Scale for Adult ADHD Type Questionnaire

Adult History Questionnaire

Rating Scale for General Symptoms Questionnaire

New patient information form

Notice of Psychologists’ Policies and Practices to Protect the Privacy of Your Health Information

General information on our standard procedures

Credit card authorization form

Consent to Release information form

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