Chapel Hill Pediatric Psychology

Chapel Hill Pediatric PsychologyChapel Hill Pediatric PsychologyChapel Hill Pediatric Psychology
  • Home
  • About Us
    • About Us
    • What Makes CHPP Unique?
    • Our Methods
    • Board of Directors
    • Staff
  • Therapists
    • Therapists
  • Clinics
    • Clinics
    • ADHD
    • Autism Spectrum Disorders
  • Services
    • Services
    • Assessments & Evaluations
    • Counseling & Therapy
    • Consultation/Educational
  • Resources
    • Resources
    • The Call-In Hour
    • Helpful Books
    • Helpful Web Sites
    • Speaker's Bureau
  • Patient Info
    • Patient Info
    • Make a Payment
    • Make an Appointment
    • Patient Forms
    • Insurance
    • Phone Consultations
    • Billing Procedures
    • Client's Rights
  • Contact Us/Directions
    • Contact Us/Directions
  • More
    • Home
    • About Us
      • About Us
      • What Makes CHPP Unique?
      • Our Methods
      • Board of Directors
      • Staff
    • Therapists
      • Therapists
    • Clinics
      • Clinics
      • ADHD
      • Autism Spectrum Disorders
    • Services
      • Services
      • Assessments & Evaluations
      • Counseling & Therapy
      • Consultation/Educational
    • Resources
      • Resources
      • The Call-In Hour
      • Helpful Books
      • Helpful Web Sites
      • Speaker's Bureau
    • Patient Info
      • Patient Info
      • Make a Payment
      • Make an Appointment
      • Patient Forms
      • Insurance
      • Phone Consultations
      • Billing Procedures
      • Client's Rights
    • Contact Us/Directions
      • Contact Us/Directions

Chapel Hill Pediatric Psychology

Chapel Hill Pediatric PsychologyChapel Hill Pediatric PsychologyChapel Hill Pediatric Psychology
  • Home
  • About Us
    • About Us
    • What Makes CHPP Unique?
    • Our Methods
    • Board of Directors
    • Staff
  • Therapists
    • Therapists
  • Clinics
    • Clinics
    • ADHD
    • Autism Spectrum Disorders
  • Services
    • Services
    • Assessments & Evaluations
    • Counseling & Therapy
    • Consultation/Educational
  • Resources
    • Resources
    • The Call-In Hour
    • Helpful Books
    • Helpful Web Sites
    • Speaker's Bureau
  • Patient Info
    • Patient Info
    • Make a Payment
    • Make an Appointment
    • Patient Forms
    • Insurance
    • Phone Consultations
    • Billing Procedures
    • Client's Rights
  • Contact Us/Directions
    • Contact Us/Directions

Patient Forms

For first time clients, please fill out the appropriate form below prior to your appointment.


Click to download and open a form (PDF)

New Patient Forms (* MUST be signed & returned)

Client Agreement for Services* (pdf)Download
Parent Questionnaire* (pdf)Download
Adult Client Questionnaire* (pdf)Download
HIPAA Consent* (pdf)Download
Insurance Release* (pdf)Download
Business Policies & Procedures (pdf)Download
North Carolina Notice (HIPAA) (pdf)Download
Patient Authorization for Use and Disclosure of Protected Health Information (pdf)Download
Medicare Notice (pdf)Download

Copyright © 2022 Chapel Hill Pediatric Psychology - All Rights Reserved.

Powered by GoDaddy

  • Privacy Policy

This website uses cookies.

We use cookies to analyze website traffic and optimize your website experience. By accepting our use of cookies, your data will be aggregated with all other user data.

Accept