Home
Our Philosophy
Our Staff
Services
Forms
Policies
Resources
Appointments
Location

 

At Family Therapeutics

we care for  children, adolescents,

and adults individually

and as families.

 

 

     

At Family Therapeutics we are dedicated to preserving our environment.

Please review our Green Policy HERE.

 

Helpful Forms

        All forms are available in Adobe Acrobat (.pdf) format

        You can download the Adobe Acrobat reader free HERE

 

Visiting us for the first time?

To find out more about our practice, please download our

Family Therapeutics Brochure

 

We like to give you every opportunity to recall important details of your past history.  We suggest that prior to your initial appointment, you download, print, and complete the following forms to help us make sure we receive all of your information.  All information submitted is confidential.

 

INITIAL EVALUATION PACKET

 

         Complete New Patient Packet

 

 

RELEASE OF INFORMATION FORM

(please complete and bring to initial appointment if you authorize us to contact any of your past treating clinicians)

           Release of Information (1 page)

 

WHAT THE GOVERNMENT REQUIRES YOU TO KNOW ABOUT YOUR HEALTH INFORMATION

           Our Privacy Practices (3 pages)

           "Our Privacy Practices" Acknowledgement (1 page)

 

FINANCIAL FORMS

Please be aware that at Family Therapeutics we do not accept any form of insurance reimbursement and are not contracted insurance providers with any company.  Should you elect to pursue reimbursement from your insurance company for our services we can provide you with a billing statement ("superbill").

           Credit Card Charge Authorization Form (1 page)

 

CLINICAL & INFORMATIONAL FORMS

FORMS FOR CHILDREN/ADOLESCENTS

           Child and Adolescent Psychiatry Screen (3 pages)

                Parents and/or Teachers to complete

           ADHD & ODD (SNAP scale) (2 pages)

                Parents and/or Teachers to complete

           Child Mania Rating Scale (3 pages)

                Parent to Complete (for Bipolar diagnosis)

           Depression Scale (CES-DC) (2 pages)

                Child to complete (Center for Epidemiological Studies)

           Child and Adolescent Anxiety Screen (3 pages)

                Child to complete (S.C.A.R.E.D. questionairre)

           GROWTH CHARTS

           Growth Chart, Boys Ages 2-20 (1 page)

           Growth Chart, Girls Ages 2-20 (1 page)

 

FORMS FOR ADULTS

              Adult ADHD Rating Scale (1 page)

                (World Health Organization Screening Tool)
           Depression Scale (CES-D) (1 page)

                (Center for Epidemiological Studies Scale)

 

   Home • Our Philosophy • Our Staff • Services • Forms • Policies • Resources • Appointments • Location

 

    Terms of Use for this Website    Family Therapeutics Brochure
   Copyright 2015 Family Therapeutics, A Corporation