In order for our clinicians and staff to prepare for your first visit to CRG, please complete and return the required forms at your earliest convenience. You may return your paperwork to CRG via mail, fax or email, or simply bring it to your initial appointment. We ask that you arrive 15 minutes early to allow us adequate time to process your information and respond to any questions you may have.
We look forward to seeing you!
CRG
9106 N. Meridian St., Ste. 100
Indianapolis, IN 46260
Fax: (317) 571-4470
Email: crg@childrensresourcegroup.com
***Please note that you will need Adobe® Acrobat® 9 or higher in order to type directly onto the forms and save your information.
All new patients need to complete the following:
- Registration Forms
- Infant Toddler Preschool Questionnaire Ages 1.5 to 5 yrs– To be completed by the parents or guardians of clients ages 1 1/2 to 5 years
- Child and Adolescent Questionnaire– To be completed by the parents or guardians of clients under the age of 18
- Adult Questionnaire– To be completed by clients ages 18 and up
- Returning Client Questionnaire – To be completed by clients who have previous been patients at CRG
Based on the type of services you are receiving, these additional forms may be requested:
- CRG Informed Consent for Telepsychiatry
- CRG Informed Consent for Telepsychology including testing
- CRG Informed Consent for Telepsychology – Group Services
- Letter Request Form
- Release of Information
- Request to Access PHI
- Teacher Information Request – Child Version
- Teacher Information Request – Adolescent Version
- Medicare Policyholders
- Tricare or Medicaid Policyholders
- Career Assessment Intake Form
- Intake Form for Dr. Parker’s Services
- Documenting Accommodations for Colleges or Testing Agencies (DACTA)
- Vanderbilt Rating Scale
