Forms & Policies
Patient Forms
Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to
your individually identifiable health information. Please review this notice carefully.
Allows patients to authorize the
disclosure of their health information to a designated individual, company, agency, or
facility
All patients must provide their consent
for treatment, communications (calls, emails, and text messaging), and agreement of
financial responsibility. Autorización y Consentimiento Para el Tratamiento
Patients are encouraged to complete and return the Preferred Contacts Form but it is not required. Contactos Preferidos
This form advises patients of their complete financial responsibility
for all medical services received without regard to insurance eligibility or coverage
determinations.
ADHD Forms
Anxiety Forms
Depression Forms
Sports Participation Forms