Patient Forms

General Admission Paperwork

Patient Data Sheet Patient Data Sheet (313 KB)

Privacy Policy (HIPPA) Privacy Policy (HIPPA) (210 KB)

Release of Information Release of Information (201 KB)

Pediatric  History Form Pediatric History Form (2916 KB)

Adult History Form Adult History Form (1939 KB)

Clinical Evaluation Admission Paperwork

Verification of Insurance Benefits Worksheet Verification of Insurance Benefits Worksheet (54 KB)

Informed Consent / Payment Policy Informed Consent / Payment Policy (555 KB)

Neurofeedback Admission Paperwork

Informed Consent / Payment Policy Informed Consent / Payment Policy (186 KB)

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