Forms for ages 11 through 17

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

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

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

Have your child complete the questionnaire below.

The parent(s)/guardian should complete the questionnaire below.

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