Forms and Policies

Stephen A. Schulman, MD Contents Forms and Policies

 

New Patients

Please print the following forms, fill them out and bring them with you to your first appointment.

  1. Authorization to Seek Medical Treatment
  2. Family History
  3. Personal History
  4. Parent/Patient Information
  5. HIPPA Policy Acknowledgment signature page.
    Please read our HIPPA Policy before signing the acknowledgment page.

NEW ADD/ADHD patients

  1. ADD/ADHD Parent Rating Form, page 1 and 2
  2. ADD/ADHD Teacher Rating Form, page 1 and 2

Returning ADD/ADHD patients for follow-up visits

  1. ADD/ADHD Assessment Follow-up Form
    Please have the teacher(s) fill this out prior to the follow-up visit

 

ADD Assessment Follow-up

ADD Assessment Follow-up Page 2

ADD Parent Rating Form

ADD Parent Rating Form Page 2

ADD Teacher Rating Form

ADD Teacher Rating Form Page 2

Authorization to Seek Medical Treatment

Parent/Patient Information

Family History

HIPAA Policy

Spanish/Solicitud de Libertad de Registros Medicos

Spanish/Informacion de los padres

Spanish/Historia Clinica del Paciente

Spanish/Historia Familiar

Personal History

Sports Physical

What we offer

Services

 
Location
Stephen A. Schulman, MD
2214 Emery St., Suite 210
Denton, TX 76201
Phone: 940-382-9448
Fax: 940-382-7509
Office Hours

Get in touch

940-382-9448