Please print and fill out the entire packet to bring with you to your appointment.
Ages 6 and under- Parents (guardians), please print and fill out the entire packet to bring with you to your child's appointment.
Please print and fill out this packet ONLY if you have been requested to do so.
Please print and fill out this form in addition to your new patient packet ONLY if you are being seen for a biofeedback session.
Please print, and circle any issues and bring to your appointment ONLY if you will be seen for neurofeedback.
Please print, fill out, sign, and then submit to either the facility holding your records or to our office.
Please print, fill out, sign, and then submit to our office and we will gladly release a copy of your records.
Note: To download Adobe Acrobat Reader for free, click here.