Patient Forms

  • Patient Forms

    Getting to know you and your child’s history is an essential first step. That’s why we begin by having you fill out our comprehensive registration packet. You can either download the TOTS registration packet and forms ahead of time, fill them all out and bring them with you or just take care of it in the office. That’ll give us a solid foundation for reviewing your child’s overall condition, which will help us determine the proper course of action.

    If you are a new patient to TOTS please download and complete all forms.  Bring the completed and signed forms with you to your child’s evaluation appointment.

    TOTS Registration Packet 2017

    Click here to Download

    Updated Patient Information 2017

    Click here to Download

    Patient Information Consent Form

    Click here to Download

    Medical Release Form

    Click here to Download

    Financial Agreement Form

    Click here to Download

    Consent for Communication via Email Form

    Click here to Download

    Clinic Physician Request Form

    Click here to Download

    Attendance and Cancellation Policy Form

    Click here to Download

    Sick Child Policy Form

    Click here to Download

    HIPAA Policy Notice Form

    Click here to Download

Questions?

Curious if your child could benefit? Consultations are free. Call today.

317-841-7005
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