Forms



General Forms:

Below are forms for your reference and include the Patient Services Agreement, which provides information regarding your rights as a patient, what to expect with your visit to PACFlorida, and information about HIPPA. In addition, you will find a copy of our Release of Information Form, which you can print out and complete if there are other professionals or individuals that you would like for us to share information with in regard to your care.


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Assessment Forms:

Below are some of the forms that we may ask you to complete. Do not worry about completing the forms below unless you are asked to do so.














Parenting Forms:
Below are some of the forms that you may be asked to complete. Do not worry about completing the forms below unless you are asked to do so.




















Homework Forms:

Depending on the treatment you are receiving, you may be asked to complete various "homework" assignments. The homework is very important to your treatment, as it will provide you with the opportunity to put the work you are doing in therapy into practice on a daily basis.









The Elimination Diet Manual: eBook Companion and Daily Diary:

This document is the Companion to our new eBook - The Elimination Diet Manual, which is a guide to helping you explore dietary sources for some of the emotional, behavioral, and physical concerns we may be experiencing. We are very happy to offer our Manual as an eBook, though the electronic version could not include the paperwork that program users need to complete. We are, therefore, providing this free download that you can print out and use as you work through the program.







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