Forms to be Filled Out by First Appointment

HIPAA FORMS
Saraosta Document
Tampa/Hyde Park Document



BASIC FORMS FOR EVERYONE

Terms and Conditions
Consent for Treatment
Release of Information from Dr Hakala
Release of Information to Dr Hakala



CHILDRENS FORMS TO BE FILLED OUT BY FIRST APPOINTMENT
Sarasota Office Child Information Form
Tampa/Hyde Park Child Information Form



PATIENT AND PERSONAL INFORMATION FORMS

Patient Information Form (For Sarasota Office)
Personal Information Form (For Sarasota Office)

Patient Information Form (For Tampa/Hyde Park Office)
Personal Information Form (For Tampa/Hyde Park Office)



 ADHD Scales
El Camino Pediatrics ADHD Home Scale
El Camino Pediatrics ADHD School Scale



SUBOXONE TREATMENT
Location Sarasota Office Tampa/Hyde Park Office
What is suboxone? Download Doucment Download Doucment
What will my first visit be like? Download Doucment Download Doucment
What do I need to bring? Download Doucment Download Doucment
Forms to be filled out by first appointment: Pretreatment Form
Family History Form
Medical History Form
Treatment Contract		 Pretreatment Form
Family History Form
Medical History Form
Treatment Contract