UAB Statement on Privacy and Medical Information Practices (PDF)
UAB
Notificación
de las Prácticas de Informaciones Médicas (PDF)
Intake Form For Clinical Evaluation
ABOUT THE INTAKE FORM
Before
you can make an appointment for your child we must obtain important information
needed to begin the process so that we can provide you with the
best possible services. You can be sure that members of the Sparks Clinics
staff will be here to assist you in any way that we can. The Form consists
of 11 pages counting the cover letter.
Please complete the form and mail it to the address provided on the
first
page of the form. A representative of Sparks Clinics will contact you
by mail usually within 3 to 5 weeks to make your first appointment. After
printing the form it is important that you complete all portions of the
form.
If you have trouble
completing
any sections of the form, the cover letter provided with
it has the contact information you need to reach us. Additional
contact information is also available here.
Printing and Completing the Intake Form Using Adobe Acrobat
If you don't have the free Acrobat Reader please click here to obtain it. The Intake Form is formatted using Adobe Acrobat. We use this format because it is faster to download and is consistent with all computers. Print the form and then complete using an ink pen rather than pencil. If you cannot print the form please use the link above to contact us. If you already have Acrobat Reader then click here to open the file and print it.
If you would prefer to save the file to your computer for printing at a later time, then right-click here and choose the "save target as" option and be sure to remember the location you are saving the file to on your computer.
If you have computer problems opening or downloading the Intake Form you may contact Jim Willett by e-mail for assistance. All inquiries about clinical services should be directed to the Sparks Clinics staff.