In response to the current situation surrounding COVID-19, Dr. Goldman will be offering only telemedicine services to all new and existing patients beginning Monday, April 13, 2020. To schedule an appointment and for more information, please call our office at 817-329-3300. We are accepting new patients at this time and look forward to meeting you.
 

Patient Forms

Begin to Write a New Chapter...

Please download and fill out the age-appropriate forms under Registration and Self-Evaluation below. All required forms must be filled out prior to first visit. Topic-specific questionnaires are optional.

New Patient Forms

Patient Registration Form

Consent to Release Information-Adult

Consent to Release Information-Minor

Self-Evaluation and Screening Forms

Adult

   Adult Self Evaluation

   Brief Psychiatric Screening-Adult

Child

   Child Self Evaluation

   Child Behavior Checklist

   Brief Psychiatric Screen-Child and Adolescent 

Disorder Specific Questionnaires and Rating

Adult Patients

   Beck Anxiety Inventory

   Sheehan Anxiety Scale

   Social Phobia Inventory

   Beck Depression Inventory

   Epworth Sleepiness Scale

   OCD Scale

   Copeland Adult ADHD

Child and Adolescent Patients

    BPRS-Parent

    KADS

    Manic Scale-for Parents

    Child’s OCD Scale-Parent version

    Child Asperger’s Syndrome Test

    Scared Child-Parent version

    Child Depression Rating Scale

    ADHD-Parent version

    Vanderbilt ADHD scale-Teacher version

Ketamine Treatment Related Forms

    Background & Consent for Ketamine

    Required Documentation for Ketamine

Please note that we must have your past records of psychiatric treatment and completed questionnaires at your initial evaluation to assess if you meet the criteria for Ketamine treatment.