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Patient Information & Financial Disclosure Form
This form collects important information about your child's health history, insurance details, and emergency contacts, ensuring we have everything needed to deliver the best possible care. It also outlines our financial policies, helping to clarify billing and insurance processes to avoid any misunderstandings.
Authorization to Disclose Protected Health Information
This form allows us to share necessary medical information with other healthcare providers or entities as specified, facilitating coordinated and comprehensive treatment. It also gives you control over what information is disclosed and for what purpose, protecting your privacy while ensuring your child receives the best possible care.
Notice of Privacy Acknowledgement
This form ensures you are aware of how your information may be used for treatment, payment, and healthcare operations, and confirms that you have received and understood our Notice of Privacy Practices. By completing this form, you help us comply with legal requirements and ensure transparent communication about your privacy rights.
ADHD Diagnosis Exam (Vanderbilt Scales)
This form helps us gather comprehensive information directly from you, the parent, about your child's attention, hyperactivity, and other related behaviors. Your detailed responses will enable us to tailor our care approach and create an effective, personalized treatment plan to address your child's specific needs.