New Patient Forms

For your convenience you can find most of the clinic's forms on this page. Please complete the forms that pertain to the type of service you are seeking to make your first appointment more efficient. If you have any questions about which forms you need to complete, do not hesitate to call us.
The .pdf forms are fillable; however, your answers cannot be saved. Please make sure to print the completed forms.

HIPPA form


Referral Form


Consent to treatment​

Caregiver's Authorization Affidavit


Demographics Form

Child Intake Questionnaire 

Adult Intake Questionnaire 


Authorization to Release Records


Financial Policy

Note  ​

For the patients seeking an evaluation:

​* It is very important that the patient is well rested and had a nutritious meal before arriving for his/her assessment appointment.

* Bring copies of any prior psychological, psychoeducational, neuropsychological testing reports and IEP paperwork to your first appointment.