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Wednesday, February 22, 2012
 
Patient Registration Form Step 1
Please fill out the form below as accurately as possible. This enables us to process our records much more efficiently, which enables us to better serve our patients. If you have any questions do not hesitate to contact us.

Family Health Care Associates of Greenbrier collects and uses your personal information to operate our clinic and deliver the services you have requested. We will not share your personal to any third party source, as it is strictly used for our patient records.
Today's Date:*
Last Name:*
First Name:*
Middle Initial:*
Sex:*
SSN:*
Date of Birth:*
Occupation:*
Address:*
City:*
State:*
Zipcode:*
Cell Phone:
Work Phone:
Emergency Contact:*
Emergency Phone:
Employer:
Employer's Address:
Spouse and/or Responsible Party (If other than patient):
Responsible Party Address:
Responsible Party Employer:
Responsible Party DOB:
I am:*
Primary Insurance:*
Secondary Insurance:
Insurance Authorization: I assign to the Provider any and all benefits from any insurance plans and direct and authorize such benefits to be paid directly to the Provider. I authorize the release of any medical information necessary to process any insurance claim.
Who may we leave messages with
at your home or work?
May we leave appointment reminder messages on your answering machine?
Home:*
Work:*
May we leave account balance information on your answering machine?
Home:*
Work:*
May we send your lab and pathology results by mail?*
If you answered NO to any of the previous questions, is there another number where we may leave messages regarding appointments, account information, lab, and pathology results?
Contact Name/Phone:
By clicking the SUBMIT button below you hereby authorize us to collect the sent data for pre-registration purposes.
ADHD News From Medical News Today
Children showing difficulty carrying out routine actions, such as getting dressed, playing with particular types of games, drawing, copying from the board in school and even typing at the computer,
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In the U.S., in 2007, the prescription medication Vyvanse was introduced for the treatment of ADHD in children aged 6 to 12 years old by the US Food and Drug Administration (FDA). The following year
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Attention-deficit/hyperactivity disorder (ADHD) affects 5-9% of youth and is frequently treated with stimulant medications, such as methylphenidate and amphetamine products. A recent safety
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It has long been known that psychostimulant drugs have the paradoxical effect of reducing hyperactivity. [Psychostimulant drugs include methylphenidate - known by the trade names Ritalin, Concerta,
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Mayo Clinic researchers have found that multiple exposures to anesthesia at a young age are associated with higher rates of attention-deficit/hyperactivity disorder (ADHD). Children exposed to two or
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A study by researchers at Mayo Clinic, Rochester Minn., and published in Mayo Clinic Proceedings, reveals that children who have been under anesthesia many times when they are young have a greater
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While children who suffer from attention-deficit hyperactivity disorder (ADHD) struggle with hyperactive-impulses and have trouble maintaining attention, a recent study found that a structured
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While pharmacologic agents have a demonstrated efficacy in children with Attention-deficit/hyperactivity disorder (ADHD), some children have suboptimal response to a single pharmacologic agent. A
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According to a report Online First by Archives of Pediatrics & Adolescent Medicine, babies who are born to mothers with diabetes during their pregnancy and/or living in low income households, have a
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Adderall is a stimulant used to treat ADHD, but it's also a controlled substance due to the addictive qualities of the drug. The DEA (Drug Enforcement Agency) monitors and controls how much of the
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