RESOURCES

NEW PATIENT FORMS

Prior to the initial appointment, please register for the Luminello patient portal and complete/submit the new patient forms at least two business days prior to the appointment. The forms can be accessed below (click on links to download):

• Patient Information

• Patient Brief History

• Release of Information

• Information and Consent Form

• Informed Consent for Telehealth

• Medicare Private Contract (For beneficiaries of Medicare only)

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A Policies & Fees form will be provided and discussed with you during your appointment. You may also access this form here. In addition, please download and review my Notice of Privacy Practices.

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You may be requested to complete clinical rating scales prior to or after you/your child's appointment:​

• Vanderbilt - ADHD Rating Scale

• ASRS - Adult ADHD Rating Scale

• PHQ-9 - Adult Depression Rating Scale

• PHQ-9 - Depression Rating Scale Parent

• PHQ-9 - Depression Rating Scale Adolescent

• CES-DC - Depression Rating Scale Child

• CMRS - Mania Rating Scale Parent

• Mood Disorder Questionnaire

• GAD-7 - Adult Anxiety Rating Scale

• SCARED - Anxiety Rating Scale Parent

• SCARED - Anxiety Rating Scale Child

• CY-BOCS - OCD Rating Scale Parent

• CY-BOCS - OCD Rating Scale Child

• Y-BOCS - Adult OCD Rating Scale

ADDITIONAL RESOURCES