When you come to our office for the first time, we’ll need you to complete the type of paperwork typically required when you see a new doctor. Please print out and complete each form and bring the completed forms to your initial visit. If you prefer to send them in advance, send them as an e-mail attachment to our staff at firstname.lastname@example.org.
Client Information Form – this form provides us with your personal contact and billing information.
Parent Questionnaire – this detailed questionnaire is intended to serve several purposes – to help parents organize their thoughts observations prior to our initial visit and prepare them to answer the types of questions they’re likely to be asked by their child’s clinician. The form also enables the clinician to spend more time addressing the problems that brought you to our practice by minimizing the need to ask lots of general questions.
Office Policies and Procedures – this document reviews all the essential elements of our service agreement with you. Please sign and return the last page.
Patient Release of Information Form – Please make sure you initial (do not check) all lines that pertain to your child. At a minimum we insist you allow us to coordinate care with your pediatrician. On the bottom portion please make sure you initial all areas as a “yes” as this information is contained in your child’s progress notes. On the back side, please indicate “yes” to those areas that pertain to your child.
Consent for Counseling or Psychological Testing – this form indictates your consent for FCBTF to provide counseling and/or psychological testing services to your child.
Fee Schedule – We believe that parents should know the cost of mental health services in advance and have the necessary information to compare our costs to those offered by other clinics and treatment facilities. Click here to download a copy of our most recent fee schedule.
You will be expected to pay for services at the time they are rendered. Our office staff will submit a claim to your insurance company on your behalf for any covered services and indicate that any and all reimbursement be sent directly to you, unless you request they not do so. We accept all major credit cards (Visa, MasterCard, Discover, AMEX), personal checks and cash as payment.
What People Say
We will forever be grateful for the kindness, professionalism and help his office provided to our son and highly recommend this practice to any parent in need of pedriatric counseling services.Parent
An excellent psychiatrist is hard to find and finding an excellent child and adolescent psychiatrist is nearly impossible. Dr. Stephen Grcevich is a rarity and I have wholeheartedly recommended him to many people.Lisa Amoroso-Johnson, PH.D
The only doctor I have dealt with who not only informs you of the medication options, but details the pros and cons of each option before deciding on the best choice together.Parent