FORMS CENTER

Forms Center

Request a prescription refill, update your insurance, pay your bill, send us external documentation, and more. 

Prescriptions

Click the button at right to request a prescription refill.

Submit Requests 5 Business Days in Advance

Do not wait until you are out of medication to request a refill!

Your provider must review and approve all prescription refill requests. Some medications require insurance pre-authorization as well.

You may be required to attend an office visit with your provider before your refill can be approved. In this case, please schedule your return visit before leaving the office.

Change of Pharmacy/Prescription

Remember to allow sufficient time (5 business days) for your request to be processed.

Requests received after 12 p.m. on Fridays, after business hours, or on weekends or holidays will be reviewed the next clinic business day.

Emergency Requests

We will try to address emergency prescription requests if possible. We do not always have a physician in the office to fill these for you. Emergency refill requests will incur a $10.00 fee.

Billing, Insurance, & Contact Information

 

Billing

Use the buttons to the right to pay your bill, or to update the credit card we keep on file for automatic payments.
If you have questions, visit the billing center to review general information or to contact the billing team. 

Insurance

If your insurance changes, please click the button at right to update that information.

Phone, Address, & Email

If you have moved, or if your email or phone number has changed, use the button to update your contact information.

External Documentation

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Current Clients

If your clinician has requested documentation from outside the Children’s Program (e.g., copies of pediatrician records, previous psychological evaluations, IEP/504 plans from your child’s school, questionnaires, etc.), you have two options:

  1. Email files to paperwork@childrensprogram.com. Please include a short explanation of the document in the body of the email, so office staff can label it correctly and add it to the correct chart.
  2. Click the button to the right to download a fillable PDF copy of a Release to Disclose Confidential Information. Complete this form, save it, and give it to your outside provider/school to authorize them to send us information via email (paperwork@childrensprogram.com) or fax (503-452-0084).

Note: Please upload scanned/PDF copies of all documents; we cannot accept photographs of paperwork taken on a phone/mobile device.

Requesting Your Records

To request copies of records from our office, please download and complete the Release to Disclose Confidential Information found on this page, email completed form to paperwork@childrensprogram.com. Please include instructions on where you would like records sent in the body of the email.

Note: As required by law, our office keeps records for 7 years from the date of the last appointment you attended. Records older than 7 years are purged and are not available. 

New/Returning Clients

Please begin by visiting the intake page and filling out a New Client Inquiry Form. Intake staff will review your inquiry, and reach out to schedule if we have available clinicians who can address your needs.

If you have already spoken to an intake specialist and scheduled an appointment with a clinician, you will receive an email and/or text message from Lobbie, our online client forms portal, to complete all required paperwork.

If you do not receive the email within 24 hours of speaking to an intake specialist, please email info@childrensprogram.com and we can re-send the link.

Please be sure to check your junk/spam folders to ensure that emails from us or from Lobbie were not caught there.

Assessment

Forms required for some of our assessment services.

Download the form, complete, then email it to our secure address: paperwork@childrensprogram.com or fax to (503) 452-0084.

Photographs of forms taken on mobile devices cannot be accepted. The fillable PDF forms require you to have Adobe Acrobat Reader to download, display and print properly. 

Forms should be submitted several days before the appointment so your clinician has time to review the information.

Language Interpreter

Complete these forms if you will require the services of an interpreter.  
Download the form, complete, then email it to our secure address: paperwork@childrensprogram.com or submit to our fax number: (503) 452-0084.
The fillable PDF forms require you to have Adobe Acrobat Reader to download, display and print properly.