LISA LOEGERING MD.

First Visit Patient Forms​

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Choose the form that best describes you or your child and print single sided. Fill out and bring them to your first visit.

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Form A : For pediatric patients > 5 years of age with problems related to attention, learning, behavior, and mental health
 

Form B : For adults and young adult patients > 14 years of age with problems related to attention, learning, behavior, and mental health
 

Form C : For young pediatric patients < 5 Years of Age with autism, developmental concerns, or other health concerns

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Form D : For patients ≥ 5 Years of Age with general health concerns
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Form E : For adult patients general health concerns