Judy’s Forms

Child Registration Forms:

Please print and fill out each form and bring Numbers 1-5 with you to your appointment

1. Child Registration

2. Child-Adol History 

3. Notice of Private Practices

4. Fee agreement

5. Disclosure Statement

6. Directions to the Office 

Adult Registration Forms:

Please print and fill out each form and bring Numbers  1-5  with you to your appointment

1. Adult Registration

2. Adult History Form

3. Notice of Private Practices

4. Fee agreement 

5. Disclosure Statement

6. Directions to the Office 

7. Telemedicine Policy