NOVEL CORONAVIRUS (COVID-19) NOTICE:
We are now treating patients via VIDEO ONLY. If you are already scheduled for an appointment, please do not come into our office. An email notice will be sent out prior to your appointment with instructions.
As of now, email is the best form of communication as our phones may be turned OFF due to the possibility of staffing remotely. Please email us at ebpgoffice@comcast.net
If you would like to read more about COVID-19 please see the Centers for Disease Control and Prevention (CDC) website: https://www.cdc.gov/coronavirus/2019-ncov/about/index.html
Evaluation forms
These are in PDF format and contain information about the evaluation, the questionnaires and other forms. Please fill out and bring them with you.
May be used for adults, 18 year old and older
May be used for ages up to 22 (for college students or patients with developmental concerns). The child eval forms include a teacher questionnaire. Please take this part to school and ask a teacher who knows the child to provide the inputs. The completed teacher form can be mailed to our office by the teacher or you can bring it with you on the day of your first appointment.
Records Request Forms
Fill out this form if you’d like EBPG to send your records to another physician or medical organization.
Consent to release and exchange 2017
Fill out this form if you’d like EBPG to request your medical records from another physician or medical organization.