Downloadable Forms

Please make sure that before requesting forms to be filled out by your provider to have the patient's name and date of birth as well as parent information filled out.

Patient Information Form:

While basic demographics can be entered and updated on the Patient Portal, the Patient Information Form must be completed at or prior to your first visit

                                      Patient Information Form

                                      HIPPA Form

For new patients please sign and fill out a Records Release form so that we may obtain your child's health records:

                                     Records Release Form

Vanderbilt Forms: If requested by your Provider as part of ADHD management:

                                     Initial ADD Evaluation form for parents

                                     Initial ADD Evaluation form for teachers

School Medication Permission Forms:

                                    Berkeley County Form

                                    Dorchester School District 2 Form

                                    Charleston County Form

Family Assistance Phone Number and Websites:

                                     Community Resource Form