***Please complete and email all forms 1-9 to drmjf@hotmail.com at least 72 hours prior to your first appointment. It is important that these forms are completed prior to your first appointment as to not delay treatment. ***
***Please bring a copy of the most recent physical exam from your child’s pediatrician (the blue school physical form is sufficient), and any other evaluations (i.e. Neuropsychological, psychoeducational) that may have been done in the past. These will need to be reviewed as part of the evaluation.***
If you have any questions please do not hesitate to ask at your appointment. Thank you!
FOR #6 PLEASE COMPLETE IF AGES 5-18 YEARS OLD PLEASE COMPLETE THE PARENT FORMS AND HAVE YOUR CHILD COMPLETE THE CHILD FORM. PLEASE BRING THE COMPLETED FORMS TO THE FIRST APPOINTMENT AS THE SCALES WILL BE SCORED FOR THE SECOND APPOINTMENT TO AVOID DELAYING TREATMENT
PLEASE HAVE PATIENT COMPLETE IF 11-17 YEARS OLD
PLEASE HAVE PATIENT COMPLETE IF 18 YEARS OR OLDER
9) Please Complete and sign a Separate Release of Information (ROI) for each of your Child’s Providers
(3 separate release forms): Pediatrician or primary care provider, School, and Therapist. If you are 18 or over and you would like information to be exchanged with family members, i.e. your parents, please complete the ROI for those family members.