Policies, Practices & Forms for GROW Patients
Please read our policies!
If you are a GROW family, or plan to be, please take some time to review ALL of our policies posted here – we have done our best to keep them as simple and easy to review as possible (while retaining all pertinent info). This information (along with the provider and staff bios) may also be helpful in deciding if we are a good fit for your family.
For statements of good health for school and camp, please email us here. We check requests daily during regular business hours. Please allow up to seven business days for your request to be completed. There is a charge of $10.00 for forms completed outside of a scheduled appointment. We are able to expedite the completion process to one-two business days as our staffing allows. Expedited form completion carries a charge of $25.00.
If you plan to request records from another provider to send to GROW, or vice versa, please use the Medical Records Request, You may then email the form to us at email@example.com.
Copies of vaccine records can be obtained through the Patient Portal, or by emailing us here. We check requests daily during regular business hours. If you are having any difficulties accessing your child’s portal, please call our office at 512-467-7334 and one of our staff will assist you.
|Flu Vaccine Questionnaire||Form||This completed form is required for all patients and parents who are receiving a flu shot from GROW.||DOWNLOAD|
|New Patient Paperwork- Family||Forms Packet||Please review ALL policies and sign these forms including: Demographics, Medical History Questionnaire, Consent to Treat, Financial Policies, Office Policies, Records Request, and ImmTrac Registration.||DOWNLOAD|
|Adolescent Patient HIPAA Consent and Release||Form||For patient’s age 16 and older, this form gives our adolescent patients the option to grant or restrict access to their personal health information.||DOWNLOAD|
|Consent to Treat||Form||Authorizes our practice to provide care to your child if a parent/legal guardian unable to make an appointment and permits another individual (grandparent, nanny, etc.) to be present.||DOWNLOAD|
|Medical Records Request||Form||Authorizes the release of medical records to or from our practice.||DOWNLOAD|
|School/Daycare Release||Form||Authorizes our practice to release patient information (Immunization Records, Statement of Good Health, etc.) to a specified third party.||DOWNLOAD|
|ADHD Initial Questionnaire||Form||Vanderbilt Assessment Scale||DOWNLOAD|
|ADHD Follow-up Questionnaire||Form||NICHQ Vanderbilt Assessment Follow-up||DOWNLOAD|
Policies and Practices
|Adolescent Confidentiality Policy||Disclosure||Explains our support of confidentiality with our adolescent patients and how we promote the collaboration between patient, parent, and provider.||DOWNLOAD|
|Financial Policy||Disclosure||Notifies you of our policies regarding the financial responsibilities associated with services rendered to your child, in compliance with the Federal Consumer Protection Act.||
|Notice of Administrative/Forms Fees||Disclosure||Informs you of fees for forms completion outside of an appointment.||DOWNLOAD|
|Notice of Privacy Practices||Disclosure||Describes how medical information about you may be used and disclosed and how you can get access to this information.||DOWNLOAD|
|Vaccine Policy||Disclosure||Describes our commitment to vaccinations for disease prevention and our ethical reasoning for this policy.||
|Vaccine Schedule||Disclosure||Lists our interpretation of the CDC recommended vaccine schedule.||