Forms | withhopeinmind

For new patients over age 18: please print out the Adult Registration Part 1 through 3 Forms, fill them out and bring to your appointment. New patients of Dr. Batenburg: use the purple buttons

New patients of Mr. Van Horn: use the black buttons.

We do not release any information about you to third parties unless you specifically consent to that.

If you want us to be able to request records from previous physicians or therapists, or to be able to communicate with others, please feel free to print out the release of information page as well.

YOU MAY EMAIL THESE FORMS BACK TO doctorstaff@mdofficemail.com.

Welcome, from C. Batenburg

Vanderbilt ADHD Rating Scale

Adult Registration Part 1

Release of Information Form

Adult Registration Part 2

Adult Registration Part 3

Child/Adolesc Registration