This form is to be reviewed and signed by parent/guardian and child/adolescent.
This form is to be signed by parent and child to indicate consent to evaluation and treatment.
This form is to be signed by parent and child to indicate consent to appointments being conducted through telemedicine.
This notice describes how medical information about your child may be used and disclosed and how you can get access to this information.
This form is to be signed by parent and child to acknowledge receipt of the HIPAA notice.
This form is to be completed by the parent prior to initial evaluation or consultation.
This questionnaire is to be completed by parents for children ages 4-10 years old.
This questionnaire is to be completed by children/adolescents ages 10-18 years old.
This form is to be completed in order to have records sent to/from Shanti Wellness and another facility or provider.
