FORMS CENTER

Forms Center

Whether it’s for prescriptions, paying your bill, or sending us required documentation, you can find it all here.

About These Forms

If you have questions about filling out these forms please call the office at (503) 452-8002 or email info@childrensprogram.com.

The fillable PDF forms require you to have Adobe Acrobat Reader to download, display and print properly.  Please download the form first, complete and email it to our secure address: paperwork@childrensprogram.com or submit to our fax number, (503) 452-0084. NOTE: This email is for receiving client documents only.

Photographs of forms taken on mobile devices cannot be accepted.

Forms must be submitted several days before the appointment so your clinician has time to review the information.

Billing

Pay your bill or check your options. Questions? Email billing@childrensprogram.com or call our billing office at (503) 452-8002 ext. 161

Insurance Carriers

You can check our list of accepted insurance carriers here.

Financial Policy

Review our financial policy.

Documentation

These forms are commonly required for service, or to schedule an appointment. Remember to submit forms as soon as possible so staff has time to review the information.

Looking for DHS Forms? Go here.

Sending Us Documentation

Current clients: If your clinician has requested documentation from outside the Children’s Program (e.g., copies of pediatrician records, previous psychological evaluations, IEP/504 plans from your child’s school, questionnaires, etc.), please email files to paperwork@childrensprogram.com.

Note: Please upload scanned/PDF copies of all documents; we cannot accept photographs of paperwork taken on a phone/mobile device.

Requesting Your Records

To request copies of records from our office, please download and complete the Release to Disclose Confidential Information found on this page, and email completed form to paperwork@childrensprogram.com. 

Note: As required by law, our office keeps records for 7 years from the date of the last appointment you attended. Records older than 7 years are purged and are not available. 

Language Interpreter

If you require a language interpreter, these forms are essential.

Prescriptions

Some conditions require an office visit with your provider before your prescription refill can be approved. In this case, please schedule your return visit before leaving the office.

Do not wait for your medication to run out. Your provider must review and approve all prescription refill requests. Some medications require insurance pre-authorization as well. Please submit your refill requests 5 days before you will run out of medication. Refill requests received after 12 p.m. on Fridays, after business hours, or on weekends or holidays will be reviewed the next clinic business day.

Change of Pharmacy/Prescription

Remember to allow sufficient time (5 days) for your request to be completed.

Emergency Requests

We will try to address emergency prescription requests if possible. We do not always have a physician in the office to fill these for you. These requests will incur a $10 fee.

Testing

Forms required for some of our testing services.