Policies & Forms
Policies
Notice of Privacy Practices
Health Insurance Portability and Accountability Act (HIPAA) notice regarding the use and disclosure of health information.
New Patient Guidelines
Overview of inital required forms and related information.
Forms
Adult Registration
Form used to register as a patient.
Pediatric Registration
Form used to register a child as a patient.
Health Care Proxy
Form and Instructions for completing a health care proxy.
Record Release Authorization
Form to authorize the release of medical records.
Health Information Consent
Consent form for regarding use and disclosure of health information.
Autism Screening 16-30 Months
Checklist used to screen for autism in toddlers.
Autism Screening Consent
Consent form for evaluation of Autism Screening checklist.
Discounted Fee Application
Application form for receiving a discounted fee schedule.
