Forms

All forms can be electronically filled (computer/tablet) or printed and completed by hand. Clear and readable cell phone pictures of completed forms are perfectly acceptable. Please do not complete forms using GoogleDocs due to formatting issues.

For patients under 18, all forms must be completed by a parent or legal guardian.

• If there is a legal custody agreement concerning a minor patient, please include a copy when you return the forms.

• If a minor patient’s parents share joint legal custody, both parents must sign a copy of the Consent and Policies Packet. It is preferable for each parent to complete an Intake Questionnaire as well, though only one is required.

• If a minor patient’s parents do not agree about pursuing treatment, Dr. Stano will determine if one parent has tie-breaking authority based on the legal custody agreement. If neither parent has tie-breaking authority, Dr. Stano may not be able to work with your child.

For patients 18 and over, the patient must sign the Consent and Policies Packet.

• Parent(s) may complete the background information sections of the Intake Questionnaire.

• If preferred, the patient and their parent(s) may each complete a copy of the Intake Questionnaire.