Willow Tree Center
Preparing For Your First Appointment
Click on a link to download the form. You may bring the completed form to your appointment or scan and email it to our office.
  • Permission form for a person other than the biological parent to consent for a  
  • Medical history form 

  • Rating scales (optional, but helpful):  
  • For ADHD:  
  • For anxiety: SCARED
  • For depression or mood disorders: PHQ-9 
  • For OCD: CY-BOCS
  • The patient's current health insurance card
  • Driver’s license or other government-issued identification (state ID card or passport) 
  • The patient’s current medications in their original pharmacy packaging or a detailed list of medications, including name of medication, dosage, when it is to be taken, and the pharmacy at which it is filled. 
  • If the patient is a minor and parents are divorced: copy of custody decree or letter from attorney stating the terms of the custody decree 
  • If the patient is a minor and you are not the biological parent of the patient: documentation that you have the legal right to consent for medical services for the patient (this may include foster care or legal guardianship forms or a signed form from the biological parent that grants permission 
  • If the patient is an adult, and you are the patient’s conservator, legal guardian or healthcare power of attorney: documentation of such legal status 
  • Copies of any previous medical records you believe to be relevant, including list of past medications, psychiatric or psychological evaluations, progress notes, blood work, hospital discharge orders, etc. 
  • Copies of any rating scales or other assessments done 
  • Copies of any educational, daycare, or other records that you believe to be relevant.