Home  About Us  Services   Prescription Request   Other Resources  Contact Us
New Patient Forms and Links

New Patient Forms and Questionnaires
Although we are providers for many major insurances, there have been changes in insurance coverage for specialists and for developmental evaluations that limit the amount that is covered, leaving a higher patient responsibility. Developmental Pediatricians firmly believe that a comprehensive evaluation is essential to properly diagnosing and developing a treatment plan to ensure optimal outcomes for children with these lifelong conditions. If your insurance doesn't cover our evaluations, we can help you find the right place to test you or your child. We are happy to work with Psychologist or school testing, to give the added holistic and integrative medical part of the evaluation and treatment. Please fill out the following contact form with patient information, main concerns and type of appointment you need (evaluation for new diagnosis, follow-up care for a previous diagnosis, or neurofeedback therapy) contact phone number and email, and send a copy of your insurance card and a copy of your photo ID to:
 adhdplus.records@att.net
or fax to 210-403-2350
We will contact you to advise on how to proceed for the full evaluation of you or your child. Thank you for your confidence in our office!
Patient Name:
Parent or Guardian:
Date of Birth:
Contact phone number:
Contact email:
Type of appointment requested:
Brief description of the medical, academic or behavior problem: