David’s Forms

Child Registration Forms:

Please print and fill out each form and bring Numbers 1-4 with you to your appointment

1. Child/Adolescent Registration Form

2. Child-Adolescent History

3. Disclosure Statement

4. Notice of Privacy Practices-Chart Copy

5. Fee Agreement

6. Directions to the Office 

Adult Registration Forms:

Please print and fill out each form and bring Numbers  1-4  with you to your appointment

1. Adult Registration Form

2. Adult History Form

3. Disclosure Statement 

4. Notice of Privacy Practices-Chart Copy

5. Fee Agreement

6. Directions to the Office 

7. Telemedicine Policy