Minor Registration Forms

Parents, for children 17 years old or younger, you must fill out the Child Registration Form along with all other forms The other forms include telephone contact, signature on file, non cancellation, financial agreement, letter and copy charges, patient notification of privacy act, patient consent form, practice policy patient agreement and combined authorization, and minor authorization agreement.

Downloading these forms and filling them out at home will keep you from needing to come 30 minutes early for your appointment. We will provide you with copies of the HIPAA policies and our office practice policies at the time of your first appointment with us.

Registration Form for a Child
Patient Notification of Privacy Rights
Patient Consent Form
Non Cancellation
Letter and Copy Charges
FINANCIAL AGREEMENT
Auth to Provide Psych Care to MinorsCombined Authorization to Release Billing-Appts.
Telephone Contact

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