Right click on the below Child & Family History Form to download and print out.  Complete and bring to the initial appointment or fax/email to me. 

✻  Child & Family History form ➤ ChildFamilyHxForm 2018 Sam.doc

✻  For your information:  The Notice of Privacy Practices refers to HIPAA and HITECH laws about the use and protection of PHI (Protected Health Information):  ➤    2013 NPP final Patient copy to sign

© Samantha Simms Piper / Piper Child Psychology 2013