Office Forms | Attention Deficit Specialists

Downloadable Forms for Your Use.

Policies and Practices Information Form 2015   (Download PDF)

This Notice explains our legal duties and privacy practice with regard to your PHI. We are required by federal law to provide you with a copy of this Notice and to abide by the terms of this Notice. Accordingly, we will ask you to sign a statement acknowledging that we have provided you with a copy of the Notice. If you have elected to receive a copy electronically, you still have the right to obtain a paper copy upon request.

 

Patient Consent Form 2015    (Download PDF)

Patient’s/Client’s Informed Consent for Psychological, Evaluation, Treatment and/or Biofeedback Training

 

Patient Intake Form 2015 – Adults     (Download PDF)

Patient Intake Form 2015 – Children/Adolescent     (Download PDF)

Please complete the Intake form (Child/Adolescent or Adult) to the best of your ability BEFORE the initial appointment if possible.  For couples, please complete a form for each member.  Clients/parents are encouraged to bring in copies of prior evaluations and testing, (including school documentation–IEPs, 504 plans, etc.).