FORMS FOR NEW PATIENTS: FORMS FOR AD/HD PATIENTS MISC FORMS
Aquaintance Form ADHD (Initial Questionairre, LONG ) Expectant Parent Form
[For initial visit, periodic updates to our files.]   [Long Form to be completed by parent after first AD/HD evaluation visit]   [To be completed when making an expectant parent visit to our office]
Financial Policy Pg 1Financial Policy Pg 2 Vandy Form, Age 4-11 (INITIAL) Minor Child: Authorization to Treat
Must be filled out for initial visit and updated whenever there is a change in insurance status.] [Age Specific Short Form to be completed by parents and teachers to monitor progress and make medication changes for patients diagnosed with ADHD] To use when a caregiver other than a parent may need to seek medical attention for the minor child at our office]
HIPPA Privacy Act   Vandy Form Age 11-18 (INITIAL)   Records Request ( FROM LAP)
[Copy of the HIPPA Privacy Policy. Please read & then complete the RECEIPT of HIPPA POLICY form]   Age specific Short Form to be completed by parents and teachers to monitor progress and make medication changes for patients diagnosed with ADHD]   [To request your child's records to transfer from LAP or to request specific parts of the record to be sent to a specialist or other entity for treatment purposes, but with the intent to stay at LAP]
Receipt of HIPPA Policy        
[Acknowledgment that you have received our HIPPA Privacy Policy, and the form on which to indicate who is allowed to have access to your child's medical records, and who may bring them in for medical care.]
Records Request (Transfering TO LAP)        
[To request your child's records from another office when transferring your child's care to our office.]