Forms

Please fill any forms out completely.

Any new patients must fill out all of the forms below. The "Authorization for Disclosure form" gives permission to people, other than parents, to access information when they call or bring the child in. This includes grandma, grandpa, aunt, uncle, babysitter, etc. Please also check any form of communication that you think you might need to use, or are willing the be contacted by, while you are at our practice.

We also ask that Patient Demo forms and Authorization for Disclosure forms be filled out once a year to make sure we have the most up-to-date records possible. If your child is 18yrs or older, they must complete the Authorization form themselves and list parents if they want to allow them access to records.


If you need a copy of your medical records or you are transferring in or out of the practice, please fill this form out.

Conner's Forms are used for gauging whether a child might have ADD/ADHD. Parent forms must be filled out by each parent individually. Teacher forms should be filled out by the child's teacher(s). Please make sure that you and the teachers answer each question; skipping questions or giving more than one answer for each question can alter the results and cause them to be inaccurate.