To facilitate a smoother and more efficient visit for you and your child, we have made available for you all the forms you will need to fill out prior to your first visit. We have also included several other forms and documents you may find useful and necessary. If there is something you need that you can not find here, please contact us here.
• Letters - A fee of $25.00 will be charged for each official letter provided by our physician and/or provider of service. (For example a diagnosis letter and/or similar letters.)
• Forms - A fee will be charged for each additional official form completed by our physician and/or provider. This includes FMLA, SSI, SCHOOL HEALTH, DISABILITY FORMS, DEPT OF MOTOR VEHICLES and similar forms. The Fee will be $15.00 for a one-page form and $25.00 for a multiple page form.
• Records - The fee for copies of medical records is $1.00 per page up to 25 pages. Each additional page will be $.25 cents as provided/allowed by the state law. Copy of CD's from EEG studies is $25.00 per study day.
You must have Adobe Reader® installed in order to view the forms. If you do not have Adobe Reader®, you can download it here for free.
Please complete the following packet in its entirety and bring the completed forms to your initial appointment.