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(Tourettes)
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PLEASE PRINT AND COMPLETE FORMS AND BRING THEM WITH YOU TO YOUR INITIAL VISIT.

NEW PATIENT FORMS

New Patients must complete forms A,B and C for first appointment. In addition, for children being seen, please also complete D. For adults, please complete E.

A. Patient Information (PDF)
B. Practice Guidelines (PDF)
C. Privacy Statement (PDF)
D. Child History (PDF)
E.
Adult History (PDF)

If you would like to pay with a credit card, please complete form F.

F. Credit Authorization(PDF)(optional)

OTHER FORMS

G. Release of Information (PDF)


© Copyright 2011 Dr. Lori Rappaport Ph.D. All rights reserved