ATTENTION: WE ARE CURRENTLY ON A WAIT-LIST FOR NEW PATIENTS OVER THE AGE OF 2 YRS OLD! ALL NEW PATIENTS/FAMILIES PLEASE FILL OUT THE PRE-REGISTRATION FORM. WE WILL BE TAKING THE PATIENTS FROM THE WAITLIST IN ORDER
New Patient/New Family Pre-Registration Form (Click Here) We will contact you once all documents are received and we have reached your name on the wait-list. Thank you for your patience. If you are pre-registering a newborn, please call for the first appointment once discharged from the hospital.
Once you have scheduled your first visit, items 1-4 below need to be completed and returned to us. Items 5-7 below are for your information and do not need to be returned to us.
- Consent Checklist for Minor Children (rev 8/2020)- Please complete and print
- New Patient Demographic Form (rev 8/2020)- Please print and complete
- Patient Portal and CHADIS Form (rev 1/2021)- Please print and complete
- Credit Card on File Form (rev 8/2020) - Please complete and print
- Policies and Fees - (rev 4/2022)
- Financial Policy - (rev 8/2020)
- Notice of Privacy Practices - (rev 8/2020)
Request for Release of Medical Records (from another Dr. to us)
HIPAA Privacy Form (Patients 18y or older) - To be completed by the 18+yr old Patient
You may be asked to bring in a completed parent and/or teacher Vanderbilt form for your child's upcoming ADHD appointment. You can find these forms by clicking on the links below.
- ADHD - Information for Families
- Vanderbilt Forms for Initial Parent and Teacher assessments
- Vanderbilt Forms for Follow-up Parent and Teacher assessments