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Patient Information

Your First Appointment
Insurance and Payment Information | Privacy Practices

The forms on this page are downloadable and printable Adobe PDF documents.
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Please arrive 30 minutes before your scheduled appointement so that your paper work can be scored and organized

Your First Appointment

Please bring the following:

• Patient's insurance card
• List of current prescriptions and/or over-the-counter medication, including dose and frequency
• Information about patient's medical and surgical history
• Recent test results, x-rays, or relevant records
• Completed patient forms
  All patients:
  • Consent to Evaluate and Treat
  • Financial Policy Agreement
  • Notice of Privacy Practices
  
  Child and adolescent patient forms:
  • Child Intake Form
  • Depression Scale for Children (CES-DC)
  • Pediatric Symptom Checklist
  • Screen for Child Anxiety Related Disorders (SCARED) - To be filled out by child
  • Screen for Child Anxiety Related Disorders (SCARED) - To be filled out by parent
  • Vanderbilt ADHD Diagnostic Parent Rating Scale
  • Vanderbilt ADHD Diagnostic Teacher Rating Scale
  
  Adult patient forms:
  • Adult Intake Form
  • Adult ADHD Self-report
  • Bipolar Rating Scale
  • Mood Disorder Questionnaire
  • Zung Depression Self-report
  • Liebowitz Social Anxiety Scale
  • Zung Self Rated Anxiety Scale

Insurance and Payment Information

Dr. Brown and The Center for ADHD are providers for Medicare and most major insurance plans, and provides insurance billing. You are responsible for co-payments or charges that are not covered by your insurance. If you have questions regarding billing or which insurance plans we accept, please contact us. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.

Privacy Practices

Our Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. It is given to all new patients, and a copy is available upon request.

Please visit our services page to learn about the specialties of our practice and visit Play Attention.