Registration & Patient Forms

Adults (18 years old or older) must fill out the Adult Registration Form along with all other forms except for the child registration and minor authorization. The other forms include telephone contact, signature on file, non cancellation, financial agreement, letter and copy charges, no authorization for work, patient notification of privacy act, patient consent form, practice policy patient agreement and combined authorization.

Parents please fill out the registration form for your child and the minor authorization along with the rest of the forms listed above

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.

IMPORTANT— Adults please fill out one of each of the below forms except for the minor authorization and the child registration form

Telephone Contact

Registration Form for a Child

Financial Agreement2

Non Cancellation2

Patient Consent Form2

Registration Form for Adults2

Auth to Provide Psych Care to Minors

Combined Authorization to Release Billing-Appts.2

Practice-policy-patient-agreement

 

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