Please download and complete the following forms and send them prior to your first appointment.
You can fax them ahead of time to (888) 977-1372 or send via mail.
For parents of children (11 and under): Please print all forms except the Adolescent background history.
For parents of adolescents (12 and over): Please print all forms (except the Child background history).
Please note: Teens can complete pgs. 5-8 of the Adolescent Background History in private.
I am happy to answer any questions you may have, and I look forward to our meeting.
Copyright © 2017 Marivic R. Dizon, PhD - All Rights Reserved.
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