Telemedicine

Instructions and forms

Instructions & Forms

Please note that virtual appointments offer limited healthcare. By signing the form below, you express understanding of the risks and benefits of telehealth visits. Before completing the required form, please read the instructions first.

Telemedicine Instructions

Telemedicine Informed Consent & Protocols

New Patient Forms

If you are scheduled for a virtual new patient visit with us, PLEASE complete the following and fax the forms prior to your appointment. If you are an existing patient, you do not have to complete these forms:

Patient Demographics Form

Initial History Intake Form

Review of Systems

Office Policies

Connors for Parents (only if you’re scheduled for ADHD evaluation and management)

Adult ADHD Questionnaire (only for patients 17+ scheduled for ADHD evaluation and management)

Headache Form (only if you’re scheduled for headache management)