Forms
These forms are available in pdf format. After you have gone through the intake process, and your appointment is scheduled, please complete and send in all appropriate forms before your first appointment. New Patient Packets include our Brochure, Parent Letter, Patient Registration, Financial Responsibility, Notice of Privacy Practices, Privacy Practices Acknowledgement, Authorization for Release/Exchange of Information and Records, Directions, Parent Questionnaire and for children who are in Kindergarten or above, please have the Teacher Questionnaire completed or for children in Preschool or Day Care, please have the Preschool questionnaire completed.
Existing Patients may also complete:
Progressions: Developmental and Behavioral Pediatrics
P.O. Box 126. 1839 Ygnacio Valley Road
Walnut Creek, CA 94598
Phone (925) 279-3480 Fax (844) 874-5965
FOR ALL LIFE THREATENING EMERGENCIES PLEASE DIAL 911
For all other emergencies, please contact your child's Pediatrician, Developmental-Behavioral Pediatrician,
Child-Adolescent Psychiatrist, Child Neurologist, or Therapist.
Time availability to communicate with Dr. Brad Berman:
Dr. Berman is available to respond to voice-mail messages or emails during the week only for a limited time on Tuesdays and all day on Thursdays, 8 am - 6pm. You may leave a message for him at 925-279-3480 or email at bradmd@att.net.
Request for medical records:
If you wish to request a copy of medical records to be sent to you, please do the following:
1. Send an email request to bradmd@att.net including your first and last name, relationship to the patient, your child's complete name, date of birth, and address.
2. Email us a completed and signed copy of a release of information form if you are requesting that medical records be sent to another professional. Please be sure to provide their correct address with this request. This form can be found at the link below for Authorization for Release/Exchange of Information and Records.
3. A copy of the requested records will be mailed to the address you provide within 30 calendar days from receipt of your request. The fee for this service will, for this moment in time, be waived,
If you must cancel or reschedule an appointment, please inform Dr. Berman as early as you can by calling at 925-279-3480 to leave a message or by email at bradmd@att.net. There is a $190 fee for all missed appointments not cancelled at least 24 hours in advance. It is your responsibility to reschedule the visit.
