Welcome to Pediatric Psychological Associates! We are looking forward to meeting you and your child. Please complete the following steps below to begin our intake process.
**Please Note: For parents who share custody (including those who are divorced, separated or never married), both parents must sign and agree for the child to be seen in our office unless the divorce or custody documents state otherwise. We require a copy of these documents.**
Step 1: REQUEST AN APPOINTMENT
- Complete New Patient Questionnaire ONLY and return via email to firstname.lastname@example.org
- New Patient Coordinator will contact you when an appoint with a provider becomes available.
- Questions can be answered by contacting our office during business hours at 502-429-5431.
Step 2: COMPLETE NEW PATIENT PAPERWORK
- Once your appointment has been scheduled, you will need to complete the following forms:
✔ New Patient Information Form
✔ Professional Services Agreement
✔ HIPAA Agreement
✔ Release of Information Form for Pediatrician/Primary Care Doctor
✔ Credit Card Authorization Form
- These forms are located at the bottom of this page and need to be completed and brought to your parent intake appointment.
Step 3: INTAKE APPOINTMENTS
- The first appointment is for parents only (your child does not attend this appointment). Having a parent-only meeting gives you the opportunity to speak freely and allows your psychologist to take a detailed history and review your current concerns. Please bring the following to your appointment:
✔ Photo ID
✔ Insurance Card
✔ All new patient paperwork
✔ Copy of any assessments or documentation that would be helpful for your Psychologist to review
- Our office recommends that all families contact their insurance company to verify mental health coverage/benefits prior to the first visit.
- The second appointment is your child's intake appointment. During that visit, your psychologist will spend the majority of the time meeting with your child. This allows your doctor time to build rapport and helps patients feel comfortable in our office.
**Please Note: When an appointment has been scheduled, the time has been reserved only for your child. If you discover that you are unable to keep a scheduled appointment please call us at 502-429-5431 at least 48 business hours in advance to cancel. This allows another child to be seen during your time.**
For directions to our office view our CONTACT/LOCATION link.
New Patient Questionnaire
Professional Services Agreement
Telehealth Parental Consent
Release of Information Form
Testing Agreement for Parents
Credit Card Authorization Form
Informed Consent for Telepsychological Services