New Family Paperwork
New client parents are asked to complete the New Family Paperwork packet.
The doctor needs this packet at least 2 business days before the parent intake.
This courtesy permits her to spend the entire appointment time directly with you.
Kindly mail it single-sided to the office or fax it to 602-386-1293.
Please allow 1 hour to complete
this packet which includes:
Release of Information Form (ROI)
A Release of Information form gives parent
permission for Dr. Onufrak to communicate
with professionals you designate. Examples include
teachers, school or daycare staff, mental health
clinicians or adjunct therapy providers (speech, OT).
Please complete separate forms for each professional
you'd like Dr. Beth to connect with.
Please complete and bring the Medical ROI
so your child's pediatrician, primary care doctor
or other physicians can coordinate care with
Dr. Onufrak if needed.
ChildSightTools Noticing Form
This is Dr. Onufrak's behavior observation form.
She uses it in her ChildSightTools seminar Clarity.
It is also very helpful families of children in individual care.
Feel free to print copies of this form to track behaviors of
concern. Bring them to the office for your intake session,
office visits or ChildSightTools seminar meetings.
If you encounter any difficulty downloading or printing
these documents, please contact us at the
main office number, (692) 386-1292.
Thank you in advance for your time
providing this important information
to the doctor.
"YOu're really good at being Dr. Beth."
- 8 yr old boy
1300 E. Missouri Ave. #230 Phoenix, AZ 85014 (602) 386-1292 DrBethKids.com
Call (602) 386-1292