Our office staff will be happy to assist you with the required documentation necessary to begin treatment with us. If you have any questions contact us at 385-215-9084.
Consent for Treatment: This form covers confidentiality and its limits and confirms that you give consent for us to treat you or your child.
HIPAA Notice: This form outlines the HIPAA law which protects patient information.
Intake Packet: This packet asks for basic contact information, insurance information, family make-up, present symptoms, and treatment history.
Electronic Payment Authorization: This page asks for a credit card to be placed on file so we can charge co-pays and no-show fees. Even if your insurance does not require a co-pay, we ask that you provide this information so we can bill you for missed appointments.
Financial Policy: This page outlines our finance policy and fee schedule. It also includes our cancellation policy and the fees that will be charged for no-shows and late cancellations.
Adverse Childhood Experiences (ACES) Questionnaire: This questionnaire asks about adverse childhood experiences and provides your ACES score. Research links ACES scores to various developmental outcomes.
Vanderbilt Parent Rating: This measure is for parents to rate the symptoms of their child.
Vanderbilt Teacher Rating: This measure is for teachers to report their observation of a child's behavior in the classroom.
We believe in the preciousness of a chilD AND THE HEALING POWER OF FAMILY CONNECTIONS