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Before we can get started, please download, complete, and return the four (4) Required Forms.
We ask that forms are returned via email or faxat least 48 hours prior to the initial appointment.
1. Health Questionnaire
2. HIPPA Compliance
3. Email Security Policy
4. Financial Policy
• Authorization to Release Medical Records (to Dr. Charny)
• Authorization to Release Medical Records (from Dr. Charny)
• Consent to Treatment of a Minor
• NTAF Questionnaire
• Brain Localization
• Diet log
• Metabolic assessment form
We are here to help!You can call or email with any questions.