Below are a number of forms you can select from once you’ve made an appointment for your first visit.  Dr Lindsley will let you know which ones she will need.  Please download the relevant files, print them and complete.  You will bring the completed forms with you to your first visit.  You will also be asked to bring a photocopy of the front and back of your insurance card (or the card itself if you do not have access to a photocopy machine).

1.  Adult sleep questionnaire

Adult Sleep Questionnaire

2.  Pediatric (to age 18) Sleep Questionnaire

Pediatric Sleep Questionnaire

3.  Pediatric Home Situation

Pediatric Home Situation

4.  Sleep, Wake and Temperature diaries

Sleep-Wake and Temperature diaries

5.  Insurance Information

Insurance Information

6.  Three forms having to do with confidentiality (HIPAA).

The first two are for your information.  Please  read and keep at home for your own records  The final form is a signature page.  Your signature on the two designated lines indicates you have read and understand each of the first two documents.  Please DO bring this with you to your first visit.

HIPAA Notice

HIPAA Client Services Agreement

HIPAA signature page

7.  Consent to Release Information

Consent to Release information