FORMS DIRECTORY

GENERAL PATIENT FORMS


If you have questions about filling out these forms please call the office at (503) 452-8002 or email info@childrensprogram.com.

The fillable PDF forms require you to have Adobe Acrobat Reader to download, display and print properly.  Please download the form first, complete and email it to our secure address: paperwork@childrensprogram.com or submit to our fax number, (503) 452-0084. NOTE: This email is for receiving client documents only.

Photographs of forms taken on mobile devices cannot be accepted.

Forms must be submitted several days before the appointment so your clinician has time to review the information.


Stored Pay Card SetupOnline Form
Consent for Telehealth ServicesOnline Form
Release to Disclose Confidential InformationFillable PDF

DHS

Looking for DHS forms? Go here.

TESTING

Vanderbilt Assessment Scale - Parent (Fillable)Download and complete on your computer, then email to clinic
Vanderbilt Assessment Scale - Parent (Printable)Print hard copy before completing, then scan/mail to clinic
Vanderbilt Assessment Scale - Teacher (Fillable)Download and complete on your computer, then email to clinic
Vanderbilt Assessment Scale - Teacher (Printable)Print hard copy before completing, then scan/mail to clinic

OTHER

Consent for Use of a Language InterpreterFillable PDF
Consent for Use of a Language Interpreter - EspañolFillable PDF

If you have questions about filling out these forms please call the office at (503) 452-8002 or email info@childrensprogram.com.

The fillable PDF forms require you to have Adobe Acrobat Reader to download, display and print properly.  Please download the form first, complete and email it to our secure address: paperwork@childrensprogram.com or submit to our fax number, (503) 452-0084. NOTE: This email is for receiving client documents only.

Photographs of forms taken on mobile devices cannot be accepted.

Forms must be submitted several days before the appointment so your clinician has time to review the information.