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
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.