Chapel Hill Pediatric Psychology

Chapel Hill Pediatric PsychologyChapel Hill Pediatric PsychologyChapel Hill Pediatric Psychology
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    • Therapists
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    • ADHD
    • Autism Spectrum Disorders
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    • Speaker's Bureau
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    • Patient Forms
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    • 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
CHPP Credit Card on File Program (pdf)Download

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