Forms for ages 10 and under

Download and complete the following forms to be brought upon initial consultation:

Patient Information

Download form below, select footer and provide patient name and insurance member ID 

*If manually entered, ensure information is provided on each page.


Consent Package

For children ages 6+, the parent(s)/guardian should complete the questionnaire below.

Parent Questionnaire

  • Instagram Social Icon
  • Facebook Social Icon
  • Twitter Social Icon

© 2017 by Alicia Vidal-Zas, Ps.D, P.A. Proudly created with