Plan Your Visit

New Patients

Before you get started, please complete:

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Step 1:  Make an Appointment

Step 2:  Read the Notice of Privacy Practices

We take privacy very seriously in our office.  Please review our Notice of Privacy Practices form below.  Then, download and sign the Acknowledgement of Receipt of Notice of Privacy Practices.  You’ll bring this form in with you when you come to our office.

Notice of Privacy Practices

Step 3:  Complete and Sign the Following Forms Prior to Your First Visit

Complete and sign the following forms prior to your first visit.  After completion, fax to (651) 356-8486 or mail them back to the office.  Bring all forms with you for your first visit.

Office Forms:

Acknowledgement of Receipt of Notice of Privacy Practices

Patient Registration Form

Release of Information

Financial Policies

Clinic Forms:

New Patient Questionnaire

The PHQ-9 and GAD-7 forms should be completed for every verbal child less than 13 years old and by the child themselves if older than 13 years of age and able.

Specific questionnaires

After Dr. Gilles has reviewed your intake information, you will be notified as to which specific questionnaires to complete prior to your child’s visit.  Please email or fax these back to the office before the visit.

Autonomic Questionnaire

Headache Diary

Headache Questionnaire

Headache Impact Test

Migraine Disability Assessment Test

Pain Questionnaire 

Wong FACES Pain Questionnaire

Seizure Questionnaire

Sensory Processing Checklist 

Sleep Questionnaire

Tic Severity Scale

Waisman Activities of Daily Living Scale

Return Visits

Please complete the What do you need? questionnaire again so Dr. Gilles can best address your current concerns.

Please complete the PHG-9 and GAD-7 each visit if your child is verbal and less than 13 years old and by the the child themselves if verbal and older than 13 years of age.

PHQ-9

GAD-7

If your insurance information has changed, please notify the office.