NEW PATIENTS

The paperwork needed for your first visit can be printed out, completed and faxed to (616) 233-9124 or mailed to our office.  It should be submitted at least one week prior to your first visit.

If you have the computer skills, the forms can be completed in Microsoft Word and emailed to omason@attention.md. If you use a different word processor, remember to save the completed form in .doc or .pdf format.

Child History form.         Children 12 and under.

Teen History form.         Teens ages 13-18 unless enrolled in college.

College History form.     College students ages 17-25 years old.

Adult History form.         Adults 19 and older unless enrolled in college.

We ask that children and teens obtain an evaluation from at least one teacher that knows the student’s capabilities well. 

Teacher Evaluation form.

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FOLLOW UP VISITS

The forms necessary for these visits can be printed out, completed and faxed to (616) 233-9124 or mailed to our office.  We need the completed form prior to the appointment time for your visit. 

If you have the computer skills, the forms can be completed in Microsoft Word and emailed to omason@attention.md.  If you use a different word processor, remember to save the completed form in .doc or .pdf format. 

Child Follow Up form.  Parent or teacher update of progress since last visit. 

Adult Follow Up form.   This form is appropriate for patients 18 years of age and older.  Copies can be given to an observer--a spouse, partner or close friend--who can give a second perspective on progress. 

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TELEPHONE AND REMOTE VISITS

Telephone visits always use the age-appropriate form above (under Follow Up Visits).

Please note that you will need to obtain pulse, weight and blood pressure readings prior to telephone visits.  These can be from your physician's office or home equipment.

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CONFIDENTIALITY NOTICE: To protect confidentiality, test faxes and test emails are required.  We use a secure email system and will respond to your email with a return email message.   Your replies to our emails are encrypted and satisfy current confidentiality standards.  Test faxes simply ensure that you are connecting properly with our equipment.