Forms
To best serve our customers, we are happy to provide our office forms for convenient download on your home computer. Please print and complete the forms below, and bring them with you to your child’s first appointment. You can also fax them to us at 801-506-0188 Questions about which forms you need? Please call our office and our courteous staff will assist you in preparing for your child’s first visit.
New Patient Forms
- Patient/Family Information Form [PDF] [Online Form]
- Patient Office Policies [PDF] [Online Form]
- HIPAA Form [PDF] [Online Form]
- Arbitration Agreement [PDF] [Online Form]
- Patient Medical History [PDF] [Online Form]
- Release of Records [PDF] [Online Form]
Other Forms
- Appointment of Personal Representative [PDF] [Online]
- Vanderbilt ADHD Assessment Scale – Teacher Informant [PDF]
- Vanderbilt ADHD Assessment Scale – Parent Informant [PDF]
In order to view or print these forms, you will need Adobe Acrobat Reader installed. Click here to download it.