Forms and Handouts

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This allows us to coordinate care with therapists, teachers, family members, or primary care physicians. You can sign it electronically. Bonus if you have contact information, but whatever you have is great.

Medical chat icon with a speech bubble and a plus sign inside
A circular icon split in half, with a sad face on the left and a happy face on the right.

If you share a patient with us, you can securely get a message directly to the clinician. Of course we’ll need permission to confirm or deny we see this patient.

Dr. Kumar will review these with you at your next appointment.

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Our agreement with all patients who are prescribed controlled substances.

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This form allows you to sent us your insurance updates so the office can bill your insurance company, and you as accurately as possible.

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A circular icon with a telephone handset and a clock inside a speech bubble, representing a call or contact time.

Use this form to send in a patient complaint, which will be reviewed by the Practice Manager and Owner of the practice.

Use this form to request a free short phone consultation with Dr. Akash Kumar.

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Fill this out if you are seeing one of our prescribers at least 3 days before your appointment! Best to be at a laptop.

Illustration of a credit card with a padlock symbol indicating security or protection of financial information.

Use this to request a prior authorization for medications if your pharmacy states you need one.

Use this form to securely update your credit card information. 

An icon of a checklist with three items, a checkmark, and a pen, enclosed in a circle.

Your clinician may have asked you to submit a request for an ADHD rating scale to be sent to your email.

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Clinic policies and our promises to you.

Use this form to request a Genetic Testing Kit be sent to your home. (only existing patients)