Forms & Downloads

Need us to complete a form? Any and all form requests for school, camp, sports, DMV, or other needs can be sent to the following email address: 

hspforms@protonmail.com

Thank you!

Forms for download:

New Patient Forms

PDF

New Patient

Intake

Form (PDF)

Are you a new patient? Welcome! Download, complete, and bring along this form to your first visit to save some time in the waiting room.

 

Must be completed by an adult over the age of 18, or a parent or guardian of a child under age 18.

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PDF

This form must be completed in order for us to process a claim through your worker's compensation or motor vehicle insurance company.

HIPAA Privacy Forms

PDF

HIPAA Notice of Privacy Form (PDF)

All Healthy Steps patients must have this form on file; please download and bring it to your first appointment, or you can fill it out when you arrive.

 

Must be completed by an adult over the age of 18, or a parent or guardian of a child under age 18.

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PDF

The NICHQ Vanderbilt Assessment Scales are used to help diagnose ADHD in children between the ages of 6 and 12 years.

Transfer to HSP

PDF

Are you transferring practices? Complete this form to authorize our practice to obtain or transfer your medical records to/from another doctor.

 

Must be completed by an adult over the age of 18, or a parent or guardian of a child under age 18.

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PDF

The NICHQ Vanderbilt Assessment Scales are used to help diagnose ADHD in children between the ages of 6 and 12 years.