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New Patient Forms
New
patients of Dr. Parks (or current patients who have moved) can now
download our forms below and either mail them to our office or bring them
in at their next scheduled appointments. Be sure to print and
then read, sign or fill out all nine of our forms below.
It is helpful (though optional) to write out a brief
summary of your problems, the history and treatments you've had, including
any medications or any special tests you've had done. Also if you have
copies of recent lab work or copies of recent medical records, please
bring these with you if available. All of these will assist in your
evaluation and consultation.
If you
have found you weren't able to fill out the forms by the time of your
appointment then please come to the office a half hour before your
scheduled time (call us in advance so we know you're coming early since
the office may otherwise be closed) so this doesn't interfere with the
time you have with Dr. Parks.
To download our forms:
In
FireFox -- Right Click on the link, and select "Save Link As"
In Internet Explorer -- Right Click on the link, and select "Save Target
As"
If you can't open these forms, Click Here
to go to the free program downloads below
(click back button on browser to return here).
1)
HIPPA Form.pdf (Read Me)
2) HIPPA Consent Form.pdf
(Sign Me)
3)
Registration
Form.pdf (Fill Me Out)
4) Registration Consent Form.pdf
(Sign Me)
5)
Patient History
Form.pdf (Fill Me Out)
6)
Neurotransmitter Assessment Form.pdf (Fill Me Out)
7)
Metabolic Assessment Form (MAF) 2009.pdf (Fill Me Out)
8)
Current
Supplements & Medications List.pdf (Fill Me Out)
9a)
Follow Up Policy Form.pdf (For Self Pay) (Sign Me)
or
9b)
Financial Party Account Responsibility Form.pdf (If Another Is
Paying) (Sign Me)
For Follow-Up Patients
Fill out the
Current
Supplements & Medications List.pdf before next visit if any changes.
Mood Charts
Upon request, we have
provided links to the mood charts we use for our follow-up
patients who find this to be helpful.
To download files:
In
FireFox --
Right Click on the link, and select "Save Link As"
In Internet Explorer -- Right Click on the link, and select "Save Target
As"
If you can't open these forms, Click Here
to go to the free program downloads below
(click back button on browser to return here).
Click Here for the
Mood Chart.xls in spreadsheet format
(to use directly from your
computer).
The above Mood
Chart is used by permission from the contributor. Our thanks for
this contribution.
or
Click Here for the
same Mood
Chart above in pdf format.
The above Mood
Chart is used by permission from the contributor. Our thanks for
this contribution.
Click Here for the Mood Chart.pdf from
ManicDepressive.org.
(If the
ManicDepressive.org website is down then
Click Here
for the same mood chart.)
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Click
Here
for the free Adobe Reader, if you find that you aren't able to view
the pdf files above.
Click Here
for the free OpenOffice.org Office Suite to use the xls file above
if you don't already have a spreadsheet program installed.
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