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Patient Forms

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Child & Adolescent Registration

Screen for Child Anxiety Related Disorders (SCARED): Child Version

Screen for Child Anxiety Related Disorders (SCARED): Parent Version

NICHQ Vanderbilt Assessment Scale: Parent Informant

NICHQ Vanderbilt Assessment Scale: Teacher Informant

HIPPA Acknowledgement of Receipt

Notice of Privacy Practices

Telehealth Consent

Authorization to Disclose Protected Health Information (PHI)

Adult ADHD Self-Report Scale

Phone: (941) 921-2792

Secondary Phone*: (941) 923-4530

*Due to some issues with our new phone system, please try calling our secondary line if you do not get a response from our primary.

Fax: (941) 925-2438

5602 Marquesas Cir., Unit 212

Sarasota, FL 34233

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