Forms & Policies
Printable Office Forms & Policies
You can quickly and conveniently access patient forms and policies from our practice here. Please bring your completed forms with you to our office at the time of your visit.
To view the forms listed below, you will need
Adobe Reader or a similar application to view PDFs.
New Patients
Most of these forms and policies will be sent to your phone and/or email via our virtual check-in service, Phreesia. If you instead wish to print them out, complete them, and bring them to your first appointment, you may do so.
- How Did You Hear About Us?
- Patient Registration & Financial Information (Demographics, Contacts, and Insurance)
- Notice of Privacy Practices (HIPAA)
- Missed Appointment Policy
- Co-Pay Policy
- Financial Policy
- Comprehensive Authorization and Consent Form
- Child Medical History: Babies UNDER 6 Months
- Child Medical History: Children 6 Months and OVER
Consents/Authorizations
School Forms
Miscellaneous
Well Check Forms
Behavioral Health Forms
- DSM 5 Checklist for Autism
- GAD-7
- Mood Disorder Questionnarie (MDQ, Screening for Bipolar Disorder)
- NICHQ Vanderbilt (ADHD) Parent Initial Form
- NICHQ Vanderbilt (ADHD) Parent Follow-Up Form
- NICHQ Vanderbilt (ADHD) Teacher Initial Form
- NICHQ Vanderbilt (ADHD) Teacher Follow-Up Form
- PHQ-9 (Adult)
- PHQ-9 (Modified for Teens)
- SCARED Anxiety Screen (child to complete)
- SCARED Anxiety Screen (parent to complete)
- SCOFF Questionnaire (screening for eating disorders)
- Spence Children's Anxiety Scale