Online Forms

Online Forms

Speed up your visit by completing the necessary form(s) below. For your convenience, you can either fill the form(s) out online or download and print the form(s) and bring it with you to your appointment.

New Patient Adult FormDownload & Print | Submit Online

Required for All Patients Over 18 Years of Age

New Patient Youth Functional History Form -  Download & Print | Submit Online

Required for All Patients From 5-18 Years of Age

TBI (Traumatic Brain Injury) History Form - Download & Print

HIPAA Authorization FormDownload & Print | Submit Online

30 Point Quality of Life Survey - Download & Print

Should be filled out if the patient has had any history of learning problems such as:

  • Dyslexia
  • Special education services
  • Reading delays
  • Excessive time spent with homework
  • Reading ability not consistent with their ability in other areas
  • A learning problem requiring the services of tutors in or outside school