Medical Forms and Requests

Forms

• Patient Registration
  • Welcome Letter
  • Registration Form
  • Consent Agreement
  • Over 18 Consent Form
  • Office and Financial Policies
  • Privacy Policy
• Medical Records Request Form
• Medical Authorization for Minors
• ADHD Assessment (Vanderbilt Form) – Teacher
• ADHD Assessment (Vanderbilt Form) – Parent
• School Entrance Form
• Virginia High School League
• Screen for Child Anxiety Related Disorders (SCARED)
• Depression Screening for Teens (PHQ-9)
• Post-COVID Return to Sports Assessment

Change of Address or Insurance?

• Insurance Update
• Address Update

Other Helpful Forms/Policies

• Conditions of Registration
• Our Privacy Practices
• Information Sharing Policy
• Prescription Refill