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Practice Forms and Documents

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  • Release of Information

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  • Notice of Privacy Practices

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  • Credit Card Policy and Change              of Credit Card

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  • Telemedicine Informed Consent

If you or a loved one feel as if you suffer from the following psychiatric difficulties, please print and fill out (or have the proper personnel fill out) the associated forms

Adult ADHD

Adult ADHD Self-Report Scale (ASRS)

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Barkley's Quick-Check for Adult ADHD Diagnosis

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Please fill out both

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ADHD in Children and Adolescents

Vanderbilt Assessment Scales for Diagnosing ADHD in Children:  To be filled out by parents and teachers​

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Please have both parents fill out (one Vanderbilt scale for each parent) if possible.  If your child has more than one teacher, please make copies and have math, science and English teachers fill out. 

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Anxiety

Generalized Anxiety Disorder 7-Item Scale (GAD-7)

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Liebowitz Social Anxiety Scale- For Social Anxiety Symptoms Only

Bipolar Disorder

Mood Disorder Questionnaire (MDQ)

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Bipolar Diagnostic Spectrum Scale (BSDS)

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Goldberg's Screening for Bipolar Spectrum Disorders

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Please fill out all three

Depression

Patient Health Questionnaire (PHQ-9)

Substance Use

Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)

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CAGE-AID Questionnaire

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Alcohol Use Disorders Identification Test (AUDIT)-For Alcohol Use Only

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