Forms

When you call the office, you’ll get my voicemail.  I schedule all appointments myself. This allows me to schedule the appropriate type of consultation or evaluation for you. Please leave a voicemail message with a brief description of why you want to consult with me along with a phone number and a good time to call you. I return messages 7 days a week, including evenings.

When you schedule your appointment, I’ll advise which forms your should print out, complete and and bring to your appointment.

Consultation for child under age 18:

1. Child Registration Form
2. HIPAA-Notice & Acknowledgement of Receipt of Privacy Practices
3. Office Policies & Consent to Treatment

Consultation for Adult

1. Adult Registration Form
2. HIPAA-Notice & Acknowledgement of Receipt of Privacy Practices
3. Office Policies & Consent to Treatment

Gifted Testing

1. Child Registration Form

Evaluation for Learning Disability, Educational/Test Accommodations for Learning Disability or Attention Deficit Disorder

1. Child Registration Form
2. Adult Registration Form
3. HIPAA-Notice & Acknowledgement of Receipt of Privacy Practices
4. Office Policies & Consent to Treatment
5. Childhood History Form

Evaluation for Developmental Disorder/Autism

1. Child Registration Form
2. Childhood History Form
3. HIPAA-Notice & Acknowledgement of Receipt of Privacy Practices
4. Office Policies & Consent to Treatment