Patient Forms

Required Software
Adobe Reader

Privacy Policy
NOTE: Please Read The Privacy Policy Before Signing the HIPAA Form.

HIPAA Form


Patient Information Form


Medical Release Form


Authorization and Consent for the Medical Treatment of a Minor


Financial Policy Form


Vaccine Policy


18+ Registration Form


18+ Financial Form


ADHD Forms
Please click on these links to download and fill out the Vanderbilt
questionnaires (one for the parents and two separate questionnaires for two
teachers who know your child’s classroom behaviors best). Everyone should
fill the forms out separately. Please have these filled out prior to the
first office visit, and bring them to your visit.

Initial Evaluation – Parent


Initial Evaluation – Teacher


Follow-up Evaluation – Parent


Follow-up Evaluation – Teacher



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