​​Call (602) 386-1292

"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

Forms




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: 


  • Demographic information forms
  • Consent for Treatment
  • HIPAA forms
  • Child History Questionnaire





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.