Forms & Policies
- Home
- /
- Forms Payment Info
- /
- Forms and Policies
For your convenience, we鈥檝e compiled a list of commonly used forms at our office. Some forms can be submitted online, while others must be completed as PDFs and sent to our office via email (info@mailppa.com) or fax (305-936-1022).
Intake & Registration Forms
- 2025 Summer Camp Registration Form
- 2025-2026 SURF & PEERS Registration Form (SURF & PEERS)
- Child History & Signature Forms*
- Historia Clinica Del Ni帽o O Adolescente*
- Adult History & Signature Forms*
- Historia Clinical Del Adulto*
- Returning Patient Abbreviated Minor Child Intake & Signature Forms* - Must be completed if minor has not had an appointment in our office within one year.
- Adult Updated Paperwork & Signatures* - use this form when the patient started at PPA as a minor and is now an adult.
- Developmental Intake & Signature Forms*
- IQ-Gifted Testing Intake Form*
- Family History (Forensic-Legal Services) & Signature Forms* - This paperwork is to be completed when parents are separated/divorced and there is legal involvement.
Office Policies & Permission Forms
- Credit Card Consent
- Autorizaci贸n de Cobros por Tarjeta de Credito
- Release of Information - This form is needed in order to communicate with other professionals, physicians, teachers, etc.
- Autorizaci贸n para la Divulgaci贸n de Archivos Psicol贸gicos Confidenciales y la Informaci贸n M茅dica Protegida - El formulario es necesario para comunicacion con tros profesionales, como medicos, maestros, etc.
- Consent for Treatment
- Consentimiento para Tratamiento
- Minor Pick-up Authorization Form - Please use if someone else outside of parent/caregiver is picking up your child from our office.
- Payment Responsibility & Agreement
- Contrato de Responsabilidad del Paciente para el Pago
- Telehealth Policies & Teletherapy Informed Consent
- P贸lizas y Consentimiento Informado para uso de la Telemedicina
* For the Intake and Group Packets, it is best to complete the forms online so we can expedite your paperwork; otherwise, please complete forms 24 hours in advance and email to:聽info@mailppa.com聽or fax to (305) 936-1022.聽 If you are unable to complete the forms ahead of time, kindly arrive 15 minutes prior to your appointment to complete paperwork.
聽
*Parael formularios de historial o registraci贸n de grupos, es mejor que los complete y los comparta al menos 24 horas antes de su cita inicial por correo electr贸nico a nuestra oficina por correo electronico: info@mailppa.com聽o por fax al (305) 936-1022. Esto ayudar谩 al m茅dico a revisar la informaci贸n antes de reunirse con la familia. Si no puede completar los formularios con anticipaci贸n, llegue a su cita con 15 minutos de anticipaci贸n para que pueda completar los formularios necesarios.
