Parkaire Consultants

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Appointment Forms

Appointment Forms

Please Read This First

During this time of the Covid-19 virus and the disruptions being caused, our procedures have changed. Please adhere to these new procedures until further notice.
To expedite the intake process, please download the appropriate documents listed on the right side of this page. They are fillable pdf forms. Please fill them out and email them to staff@parkaireconsultants.com at least two days before your appointment.

For your initial intake appointment with Sheryl Pruitt,
please do not involve your child. The initial intake session
should be attended by the adult parent or guardian only.

The following forms should be printed and completed by you for your intake appointment with Sheryl K. Pruitt:

• Parkaire Intake Form for appropriate age
• Consent for Treatment of Minor (if applicable)
• Parkaire Billing Policy
• HIPAA Consent Form
• Telecommunication Consent Form
• Parkaire Release Form
• Family History Form
• Medication History Form

These forms need to be completed by you and sent to us for your appointment with Sherry Pruitt.

Policy Regarding Records Review

Please provide us with any previous documentation you would like us to review at least seven business days prior to your first visit. (Copies of neuropsychological assessments, IEP documentation, school records, etc. Please do not send your original copies.)

We cannot guarantee documentation review for paperwork provided less than seven business days prior to your intake appointment.

Any documentation provided less than seven days prior to your initial appointment will be read before your second appointment. There will be an applicable fee for the review of any documents that are more than 25 pages in length cumulatively, as this takes a significant amount of time to read/review.

Please send them to staff@parkaireconsultants.com. If you have need help scanning the documents, please mail them or drop them off. Again, please do not send your originals.

Intake Appointment Forms

  • Intake Form for Adults over 18
  • Intake Form for Children or Adolescents Under 18
  • Consent for Treatment of Minor
  • Parkaire Billing Policy
  • HIPAA Consent Form
  • Telecommunication Informed Consent
  • Parkaire Release Form
  • Family History Form
  • Medication History Form

Authorization to Release Form

  • Authorization to Release Form

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