Patient Forms

Please find the most commonly used forms in our practice. You will be able to electronically access and sign them once your appointment has been confirmed.

First Appointment Forms:

• • Notice of Privacy Practices
  • Financial Responsibility
  • Consent to Treatment

Forms used for your Well Child evaluations during the first six months:

• • Edinburgh Scale

Forms used for your Well Child evaluation at 18 & 24 months:

• • MCHAT

Forms used at all of your Well Child Evaluations:

• • Lead & TB Screen

Form used authorized the release of your medical record TO Phycinity:

• • Authorization for Release of Information To Phycinity

Moving or PCSing out of the area? We are here to make the transition as smooth as possible. Here is the form to authorize Phycinity PLLC release medical information to your new practice:

• • Authorization For Release of Information From Phycinity