Forms

before you visit …

If you are visiting us for the first time, the forms below can help us get you in faster! Instead of filling them out in our office when you visit, you can fill out many of our patient registration and intake forms online beforehand. If you need to use any of the other forms you can print them out, fill them in at your convenience, and bring them in with you.

General Forms

• New Patient Appointment Request Form
• Authorization for Release of Medical Records and PHI
• Consent for Telehealth Services
• Anthem Verification Release Form
• Current Notice of Privacy Practices (PDF)

Child Forms

• Child and Adolescent Intake Packet
• Child and Adolescent Testing Supplement Form
• Consent for Mental Health Treatment of Minors
• Child / Adolescent Testing Report Release Form

Adult Forms

• Adult Intake Packet
• Adult Testing Supplemental Forms
• Adult Testing Report Release Form

Co-parenting Forms

• Co-Parenting Coaching Registration Packet

Medication Management Forms

• Patient Medication Management Registration Packet

Rachel Gladstone Forms

• Authorization for the Release of Medical Records and PHI with Rachel Gladstone
• Intake Packet for Educational Consultations with Rachel Gladstone

Speech Language Pathology Forms

• Intake
• Release Form