We are happy to provide our office forms for convenient online secure submission. Questions about which forms you need to fill out? Please call our office and our staff will assist you in preparing for your visit.
New Patient Forms:
Please fill out prior to your first appointment.
- General Intake Form (all new patients, counseling and medical)
- Health Questionnaire (all new patients, counseling and medical)
- Counseling Intro Letter (counseling patients please read this first!)
- Counseling Client Intake Form (new counseling patients only)
- Disclosure Document for NL/NC Psychotherapists (new counseling patients only)
- Release of Information Form (for requesting old records, to allow communication between schools and practice/counselor, or for communication with specialists, this one can be a little confusing so don't hesitate to call!)
Well Visits Forms:
Save time at your visit! Click on the links below and fill out the developmental screeners and health history updates electronically, it will be sent to our office securely and ready for your visit!
- Annual Health History Update (please complete at each yearly well visit)
- Ages and Stages Developmental Screener (ASQ) (please complete both the age approriate ASQ and the ASQ-SE for all visits from 6 months to 4 years)
- Dental Risk assessment (please complete for all well visits between 6 months and 3 years)
- MCHAT (please complete for your 18 month and 2 year well visit)
Mental Health Visits:
- Anxiety Screener (GAD7)
- Depression Screener (PHQ9)
- ADHD: Teacher (Vanderbilt)
- ADHD: Parent (Vanderbilt)
Asthma Visits: