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609 Price Ave # 104
Redwood City, CA 94063
650-365-1109
[email protected]

650-365-7720 fax

Patient Forms

We are also happy to offer you the option to download, print and complete our office forms to reduce wait times during your first appointment.

• Release of Medical Records-when you need a copy of your  medical records or are transferring to a new pratice/physician
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•         There is a 25$ fee per medical record. This is payable by phone to our office with a credit, HSA or debit card, or you may mail a check, or come by with a cash payment. Once we have the signed release and payment we will prepare the records onto a CD, these records will wil take up to 10 wokring days. CD's may be picked up or we will mail it to you within the United States. We do not mail CD's oversees. We do not supply paper records. We only supply a CD- PDF file for you to hold onto and provdie copies to other physicians.

**For patients that were with Kid Kare- those records if we have them in storage will be included on the CD.

• Authorization for use and Disclosure of Medical Information- when you need a previous MD or specialist to send us records for onging care.

• Vanderbilt Teacher- if you need for an ADHD evaluation
• Vanderbilt Parent- if you need for an ADHD evaluation

• Privacy Practices (this document is for your records)
• HIPPA Acknowledgement Form (This form is required to be on file at our office for all families)

In order to view or print these forms you will need Adobe Acrobat Reader installed.
Click here to download it.

CONTACT US

Questions or Comments?
We encourage you to contact us whenever you have an interest about our services.