Patient Forms

Download, fill out and bring them in with you!

Click the links below to download:

(You will also need to have Adobe Reader installed to view these forms – you can download and install the program for free by clicking the Adobe Reader icon below.)

Patient Registration Form – English & Spanish

Patient Consent to Treatment Form – English

Patient Consent to Treatment Form – Spanish

Patient and Center Rights and Responsibilities – English & Spanish

Notice of Privacy Rights – English & Spanish

Failure to Provide Proof of Income Form – English & Spanish

General Consent Form to Share Information – English

General Consent Form to Share Information – Spanish

Release of Information Form – English

Release of Information Form – Spanish

Release of Pediatric ADD/ADHD Policy – English

Release of Pediatric ADD/ADHD Policy – Spanish

Click to download and install Adobe Reader for free. You need this program to view the forms.

Patient Forms

Patient Forms

Download, fill out and bring them in with you!

Click the links below to download:

Patient Registration Form – English & Spanish

Patient Consent to Treatment Form – English

Patient Consent to Treatment Form – Spanish

Patient and Center Rights and Responsibilities – English & Spanish

Notice of Privacy Rights – English & Spanish

Failure to Provide Proof of Income Form – English & Spanish

General Consent Form to Share Information – English

General Consent Form to Share Information – Spanish

Release of Information Form – English

Release of Information Form – Spanish

Release of Pediatric ADD/ADHD Policy – English

Release of Pediatric ADD/ADHD Policy – Spanish

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