HQ Form ( Child – English )
HQ Form ( Adult – English )
HIPPA Privacy Notice Form
Receipt of Notice of Privacy Practices
HQ Form ( Child – Spanish )
HQ Form ( Adult – Spanish )
HIPPA Privacy Notice Form (Spanish)
Receipt of Notice of Privacy Practices (Spanish)
Patient Records Release Authorization Form
Deband Release Form
You must bring both forms filled out and signed for your following appointments.
If you can, please help us with this. Thank you.
AAOIC Supplemental Informed Consent
Supplemental Health Questionnaire