Please complete the appropriate forms prior to your appointment. Forms can be either printed, completed and brought to the intake appointment or emailed to us at firstname.lastname@example.org.
Be sure to bring your health insurance card to the appointment.
For medication management appointment with Dr. Bartz:
Provider Referral Form
For a psychotherapy or neuropsychological assessment appointment:
Release and Exchange of Information (for your physician, school, and any other providers)
Teacher Rating Scales (ask 1-2 teachers who know your child well to complete these scales)
To complete, after clicking on the appropriate link below, click the Download button and choose “Open with Adobe Acrobat” and save to your desktop before sending.