Patient Forms

HIPAA Acknowledgement

Step 1: Download this form and read thoroughly for your right to privacy under HIPAA: HIPAA Notice Brochure

Step 2: Please eSign this form and save it to your computer, or print, sign and scan this form to your computer. You will need to upload it to the form below: HIPAA Acknowledgement Form

Please print and complete the appropriate forms below. Please email them to info@alzeinpeds.com and bring them to your first appointment. If you have any questions, please arrive a few minutes early so our staff can assist you.

Thank you!

Please download and complete the appropriate age development questionnaire below.

In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.