Thank you for your interest in our center. Before your child’s scheduled appointment, you will receive a secure link to create a Patient Ally account for your child where you can access electronic forms including information about our practice policies and a Parent Questionnaire. Please complete these at least 5 days prior to your child’s appointment to avoid the need to reschedule the appointment.

In addition to the forms on Patient Ally, please provide the teacher forms below to your child’s teacher. In addition, please complete the parent forms listed below. Please bring completed parent and teacher forms to your child’s first in person appointment.

Developmental Consultation (2-5 years)

Teacher Questionnaire Preschool

Preschool ADHD Rating Scale (Parent)

Preschool ADHD Rating Scale (Teacher)

Preschool Anxiety Scale (Parent)

Developmental Consultation (6-7 years)

Teacher Questionnaire School-Aged (ages 6-10)

Vanderbilt Rating Scale (Parent)

Vanderbilt Rating Scale (Teacher)

Spence Children’s Anxiety Scale (Parent)

Developmental Consultation (8-10 years)

Teacher Questionnaire School-Aged (ages 6-10)

Vanderbilt Rating Scale (Parent)

Vanderbilt Rating Scale (Teacher)

SCARED Rating Scale (Parent)

Additional Forms

Authorization to Exchange Medical Records and Information with School

Authorization to Exchange Medical Records and Information with Health Care Providers

Mass General Brigham Patient Gateway Consent

Mass General Brigham Patient Gateway Instructions

Notice of Privacy Practices

For Referring Providers:

Request for Consultation

Provider Referral Form