Consent Forms & Policy Documents | Siskin Children's Institute

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Thank you for choosing the Siskin Children’s Institute.

Below you will find the most common parent forms and policies for your convenience.

If you are looking for a document not provided here, please don’t hesitate to call our main office at 423.490.7710 and a staff member will assist you.

For medical record inquiries please login to your Patient Portal.

If you do not have a Patient Portal login please complete a Medical Records request via our Contact form.

ABA Therapy Forms

Behavior Health Center of ExcellenceAnnouncement Letter

Medical/Therapy Forms

New PatientParent Form – Chattanooga

New PatientParent Form – Nashville

Patient Visit Approval Authorization

ADHD Parent Assessment

Medical Record OBTAIN

Medical Record RELEASE

Schools / Teachers

ADHDTeacher Assessment

Office Policies

Patient Office Policy

Proof of Guardianship Policy

Therapy Attendance Letter

Notice of Privacy Practices

Billing & Insurance Payment Policy

Siskin Children's Institute seeks to affirm the dignity and worth of every person. It is, therefore, the policy of the Institute to practice and ensure the fair and equitable treatment of all constituents with respect to race, religion, ethnicity, national origin, political belief, socio-economic status, age, gender, sexual orientation, or disability. The Institute promotes the full realization of this policy through all organizational practices including admission and participation in programs and medical services.