For New Patients
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 your initial visit is a virtual visit or you prefer to send the completed forms in advance, send them as an e-mail attachment to Dr. Grcevich 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 Dr. Grcevich in your initial appointment. The form also enables Dr. Grcevich to spend more time addressing the problems that brought you to our practice by minimizing the need to ask lots of general questions.
Practice 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 or primary care physician. 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.
Good Faith Estimate of Initial Evaluation and Ongoing Treatment Costs - 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 for information on the cost of psychiatric evaluation, our fee schedule, charges for follow-up appointments and data from our practice in 2021 on the frequency of follow-up visits. Informational only - new families need not return this estimate with the other paperwork.
Payment - We require you keep a current credit card on file that will be used to collect payment in full for services, generally within a few days of a clinical encounter or completing a requested service. You may pay by cash, check, money order, Visa, Master Card, Discover or American Express, but you are still required to keep a credit card on file.