{"id":1376784,"date":"2023-07-31T17:46:12","date_gmt":"2023-07-31T17:46:12","guid":{"rendered":"https:\/\/mmandcc.com\/?page_id=1376784"},"modified":"2024-02-01T07:30:50","modified_gmt":"2024-02-01T12:30:50","slug":"forms","status":"publish","type":"page","link":"https:\/\/mmandcc.com\/es\/patient-services\/forms\/","title":{"rendered":"Forms"},"content":{"rendered":"\n[et_pb_section fb_built=”1″ _builder_version=”4.21.0″ _module_preset=”default” background_color=”#002959″ use_background_color_gradient=”on” background_color_gradient_stops=”#002959 0%|rgba(0,41,89,0.63) 100%” background_color_gradient_overlays_image=”on” background_image=”https:\/\/mmandcc.com\/wp-content\/uploads\/2023\/07\/hero-04.jpg” parallax=”on” parallax_method=”off” custom_padding=”120px||0px||false|false” border_width_bottom=”5px” border_color_bottom=”#7CDA24″ saved_tabs=”all” global_colors_info=”{}”][et_pb_row _builder_version=”4.21.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.21.0″ _module_preset=”default” global_colors_info=”{}”][dsm_block_reveal_text block_reveal_text=”Patient Forms” block_reveal_color=”#7CDA24″ _builder_version=”4.22.1″ _module_preset=”default” header_font=”|700|||||||” header_text_align=”left” header_text_color=”#E2FAD1″ header_font_size=”40px” header_text_align_tablet=”” header_text_align_phone=”center” header_text_align_last_edited=”on|phone” global_module=”1377285″ saved_tabs=”all” locked=”off” global_colors_info=”{}”][\/dsm_block_reveal_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ specialty=”on” _builder_version=”4.21.0″ _module_preset=”default” use_background_color_gradient=”on” background_color_gradient_stops=”rgba(255,255,255,0.86) 1%|rgba(255,255,255,0.82) 100%” background_color_gradient_overlays_image=”on” background_enable_image=”off” parallax=”on” animation_style=”fade” animation_direction=”right” global_colors_info=”{}”][et_pb_column type=”2_3″ specialty_columns=”2″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_row_inner disabled_on=”on|on|on” _builder_version=”4.21.0″ _module_preset=”default” disabled=”on” global_colors_info=”{}”][et_pb_column_inner saved_specialty_column_type=”2_3″ _builder_version=”4.21.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_text _builder_version=”4.21.0″ text_font=”|500|||||||” text_text_color=”#545454″ text_line_height=”1.8em” header_3_text_color=”#002959″ header_3_font_size=”36px” header_4_font=”|700|||||||” header_4_text_color=”#3FA8F4″ header_4_font_size=”24px” animation_direction=”right” locked=”off” global_colors_info=”{}”]

Title here<\/h3>\n

Sub-Heading Here<\/h4>\n

Sed ut perspiciatis unde omnis iste natus error sit voluptatem accusantium doloremque laudantium, totam rem aperiam, eaque ipsa quae ab illo inventore veritatis et quasi architecto beatae vitae dicta sunt explicabo.\u00a0<\/span><\/p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner _builder_version=”4.21.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_column_inner saved_specialty_column_type=”2_3″ _builder_version=”4.21.0″ _module_preset=”default” custom_css_main_element=”display: flex;||flex-direction: row;||flex-wrap: wrap;||gap: 30px;” global_colors_info=”{}”][et_pb_blurb title=”New Patient Form” use_icon=”on” font_icon=”||fa||400″ icon_color=”#002959″ image_icon_background_color=”RGBA(255,255,255,0)” image_icon_width=”95px” content_max_width=”150px” content_max_width_tablet=”130px” content_max_width_phone=”130px” content_max_width_last_edited=”on|phone” _builder_version=”4.22.1″ _module_preset=”default” header_font=”|600|||||||” header_text_color=”#002959″ header_font_size=”18px” text_orientation=”center” link_option_url=”https:\/\/mmandcc.com\/wp-content\/uploads\/2023\/08\/Med-Intake-Forms.pdf” link_option_url_new_window=”on” border_radii_image=”on|1px|1px|1px|1px” global_colors_info=”{}” transform_styles__hover_enabled=”on|desktop” transform_scale__hover=”105%|105%” transform_scale__hover_enabled=”on|desktop” transform_translate__hover_enabled=”on|desktop” transform_rotate__hover_enabled=”on|desktop” transform_skew__hover_enabled=”on|desktop” transform_origin__hover_enabled=”on|desktop”][\/et_pb_blurb][et_pb_blurb title=”Depression Scale” use_icon=”on” font_icon=”||fa||400″ icon_color=”#002959″ image_icon_background_color=”RGBA(255,255,255,0)” image_icon_width=”95px” content_max_width=”150px” content_max_width_tablet=”130px” content_max_width_phone=”130px” content_max_width_last_edited=”on|phone” _builder_version=”4.22.0″ _module_preset=”default” header_font=”|600|||||||” header_text_color=”#002959″ header_font_size=”18px” text_orientation=”center” link_option_url=”https:\/\/mmandcc.com\/wp-content\/uploads\/2023\/07\/CES-Depression-Scale1.pdf” link_option_url_new_window=”on” border_radii_image=”on|1px|1px|1px|1px” global_colors_info=”{}” transform_styles__hover_enabled=”on|desktop” transform_scale__hover=”105%|105%” transform_scale__hover_enabled=”on|desktop” transform_translate__hover_enabled=”on|desktop” transform_rotate__hover_enabled=”on|desktop” transform_skew__hover_enabled=”on|desktop” transform_origin__hover_enabled=”on|desktop”][\/et_pb_blurb][et_pb_blurb title=”Family Media Agreement” use_icon=”on” font_icon=”||fa||400″ icon_color=”#002959″ image_icon_background_color=”RGBA(255,255,255,0)” image_icon_width=”95px” content_max_width=”150px” content_max_width_tablet=”130px” content_max_width_phone=”130px” content_max_width_last_edited=”on|phone” _builder_version=”4.22.1″ _module_preset=”default” header_font=”|600|||||||” header_text_color=”#002959″ header_font_size=”18px” text_orientation=”center” link_option_url=”https:\/\/mmandcc.com\/wp-content\/uploads\/2023\/09\/common_sense_family_media_agreement.pdf” link_option_url_new_window=”on” hover_enabled=”0″ border_radii_image=”on|1px|1px|1px|1px” global_colors_info=”{}” transform_styles__hover_enabled=”on|desktop” transform_scale__hover=”105%|105%” transform_scale__hover_enabled=”on|desktop” transform_translate__hover_enabled=”on|desktop” transform_rotate__hover_enabled=”on|desktop” transform_skew__hover_enabled=”on|desktop” transform_origin__hover_enabled=”on|desktop” url_new_window=”on” sticky_enabled=”0″][\/et_pb_blurb][et_pb_blurb title=”ADHD Symptom Checklist” use_icon=”on” font_icon=”||fa||400″ icon_color=”#002959″ image_icon_background_color=”RGBA(255,255,255,0)” image_icon_width=”95px” content_max_width=”150px” content_max_width_tablet=”130px” content_max_width_phone=”130px” content_max_width_last_edited=”on|phone” _builder_version=”4.22.0″ _module_preset=”default” header_font=”|600|||||||” header_text_color=”#002959″ header_font_size=”18px” text_orientation=”center” link_option_url=”https:\/\/mmandcc.com\/wp-content\/uploads\/2023\/07\/adhd-symptom-checklist.pdf” link_option_url_new_window=”on” border_radii_image=”on|1px|1px|1px|1px” global_colors_info=”{}” transform_styles__hover_enabled=”on|desktop” transform_scale__hover=”105%|105%” transform_scale__hover_enabled=”on|desktop” transform_translate__hover_enabled=”on|desktop” transform_rotate__hover_enabled=”on|desktop” transform_skew__hover_enabled=”on|desktop” transform_origin__hover_enabled=”on|desktop”][\/et_pb_blurb][et_pb_blurb title=”Drug Use Screening” use_icon=”on” font_icon=”||fa||400″ icon_color=”#002959″ image_icon_background_color=”RGBA(255,255,255,0)” image_icon_width=”95px” content_max_width=”150px” content_max_width_tablet=”130px” content_max_width_phone=”130px” content_max_width_last_edited=”on|phone” _builder_version=”4.22.0″ _module_preset=”default” header_font=”|600|||||||” header_text_color=”#002959″ header_font_size=”18px” text_orientation=”center” link_option_url=”https:\/\/mmandcc.com\/wp-content\/uploads\/2023\/07\/Drug-Use.pdf” link_option_url_new_window=”on” border_radii_image=”on|1px|1px|1px|1px” global_colors_info=”{}” transform_styles__hover_enabled=”on|desktop” transform_scale__hover=”105%|105%” transform_scale__hover_enabled=”on|desktop” transform_translate__hover_enabled=”on|desktop” transform_rotate__hover_enabled=”on|desktop” transform_skew__hover_enabled=”on|desktop” transform_origin__hover_enabled=”on|desktop”][\/et_pb_blurb][et_pb_blurb title=”School Health Form” use_icon=”on” font_icon=”||fa||400″ icon_color=”#002959″ image_icon_background_color=”RGBA(255,255,255,0)” image_icon_width=”95px” content_max_width=”150px” content_max_width_tablet=”130px” content_max_width_phone=”130px” content_max_width_last_edited=”on|phone” _builder_version=”4.22.1″ _module_preset=”default” header_font=”|600|||||||” header_text_color=”#002959″ header_font_size=”18px” text_orientation=”center” module_alignment=”center” link_option_url=”https:\/\/mmandcc.com\/wp-content\/uploads\/2023\/08\/school-health-forms.pdf” link_option_url_new_window=”on” border_radii_image=”on|1px|1px|1px|1px” global_colors_info=”{}” transform_styles__hover_enabled=”on|desktop” transform_scale__hover=”105%|105%” transform_scale__hover_enabled=”on|desktop” transform_translate__hover_enabled=”on|desktop” transform_rotate__hover_enabled=”on|desktop” transform_skew__hover_enabled=”on|desktop” transform_origin__hover_enabled=”on|desktop”][\/et_pb_blurb][et_pb_blurb title=”Mental Health Screening” use_icon=”on” font_icon=”||fa||400″ icon_color=”#002959″ image_icon_background_color=”RGBA(255,255,255,0)” image_icon_width=”95px” content_max_width=”150px” content_max_width_tablet=”130px” content_max_width_phone=”130px” content_max_width_last_edited=”on|phone” _builder_version=”4.22.0″ _module_preset=”default” header_font=”|600|||||||” header_text_color=”#002959″ header_font_size=”18px” text_orientation=”center” module_alignment=”center” link_option_url=”https:\/\/mmandcc.com\/wp-content\/uploads\/2023\/08\/Questionnaire-Anxiety-Screen.pdf” link_option_url_new_window=”on” border_radii_image=”on|1px|1px|1px|1px” global_colors_info=”{}” transform_styles__hover_enabled=”on|desktop” transform_scale__hover=”105%|105%” transform_scale__hover_enabled=”on|desktop” transform_translate__hover_enabled=”on|desktop” transform_rotate__hover_enabled=”on|desktop” transform_skew__hover_enabled=”on|desktop” transform_origin__hover_enabled=”on|desktop”][\/et_pb_blurb][\/et_pb_column_inner][\/et_pb_row_inner][\/et_pb_column][et_pb_column type=”1_3″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_image src=”https:\/\/mmandcc.com\/wp-content\/uploads\/2023\/07\/IMG-8335-1.jpg” title_text=”Blue with Stork Illustration Baby Instagram Post – 3″ align=”center” force_fullwidth=”on” _builder_version=”4.22.0″ _module_preset=”default” animation_direction=”right” box_shadow_style=”preset3″ global_colors_info=”{}”][\/et_pb_image][\/et_pb_column][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”4.21.0″ _module_preset=”default” background_color=”#E2FAD1″ background_enable_image=”off” parallax=”on” parallax_method=”off” background_pattern_repeat_origin=”center” global_module=”1376698″ saved_tabs=”all” global_colors_info=”{}”][et_pb_row column_structure=”1_3,1_3,1_3″ module_id=”bios” _builder_version=”4.21.0″ _module_preset=”default” animation_style=”slide” animation_direction=”bottom” locked=”off” global_colors_info=”{}”][et_pb_column type=”1_3″ _builder_version=”4.21.0″ _module_preset=”default” link_option_url=”#” global_colors_info=”{}” transform_styles__hover_enabled=”on|hover” transform_scale__hover_enabled=”on|hover” transform_translate__hover_enabled=”on|desktop” transform_rotate__hover_enabled=”on|desktop” transform_skew__hover_enabled=”on|desktop” transform_origin__hover_enabled=”on|desktop” transform_scale__hover=”105%|105%”][et_pb_blurb title=”Dr. Roman Criollo, MD” image=”https:\/\/mmandcc.com\/wp-content\/uploads\/2023\/07\/roman-bio-01.jpg” alt=”Roman Criollo” _builder_version=”4.22.1″ _module_preset=”default” header_level=”h3″ header_font=”|700|||||||” header_text_color=”#3FA8F4″ border_radii_image=”on|50%|50%|50%|50%” global_colors_info=”{}”]

Pediatrician<\/em><\/h4>\n

I am a board certified pediatrician with 15 plus\u00a0 years of experience and I speak English and Spanish. I offer wellness visits, sports physicals, school physicals, ADHD\u00a0 management, newborn visits, and pre-op exams. I see patients from newborn to 19 years of age.\u00a0<\/span><\/p>[\/et_pb_blurb][et_pb_button button_url=”@ET-DC@eyJkeW5hbWljIjp0cnVlLCJjb250ZW50IjoicG9zdF9saW5rX3VybF9wYWdlIiwic2V0dGluZ3MiOnsicG9zdF9pZCI6IjEzNzY2NzcifX0=@” button_text=”Read Bio” button_alignment=”center” _builder_version=”4.21.0″ _dynamic_attributes=”button_url” _module_preset=”default” custom_css_main_element=”width: 100%;||text-align: center;” global_colors_info=”{}”][\/et_pb_button][\/et_pb_column][et_pb_column type=”1_3″ _builder_version=”4.21.0″ _module_preset=”default” link_option_url=”#” global_colors_info=”{}” transform_styles__hover_enabled=”on|hover” transform_scale__hover_enabled=”on|hover” transform_translate__hover_enabled=”on|desktop” transform_rotate__hover_enabled=”on|desktop” transform_skew__hover_enabled=”on|desktop” transform_origin__hover_enabled=”on|desktop” transform_scale__hover=”105%|105%”][et_pb_blurb title=”CC Criollo, MSW, RCSWI” image=”https:\/\/mmandcc.com\/wp-content\/uploads\/2023\/07\/dd-bio-01.jpg” alt=”CC Criollo” _builder_version=”4.22.1″ _module_preset=”default” header_level=”h3″ header_font=”|700|||||||” header_text_color=”#3FA8F4″ border_radii_image=”on|50%|50%|50%|50%” global_colors_info=”{}”]

Therapist<\/em><\/h4>\n

I am a Mental Health Therapist and Life Coach. I have over 10 years of experience and specialize in working with a variety of diagnosis including Attention Deficit Hyperactivity disorder (ADHD), Attention Deficit disorder (ADD), Anxiety, Low-mild Depression, and Family Dynamic\u2019s.<\/span><\/p>[\/et_pb_blurb][et_pb_button button_url=”@ET-DC@eyJkeW5hbWljIjp0cnVlLCJjb250ZW50IjoicG9zdF9saW5rX3VybF9wYWdlIiwic2V0dGluZ3MiOnsicG9zdF9pZCI6IjEzNzY2NjcifX0=@” button_text=”Read Bio” button_alignment=”center” _builder_version=”4.22.1″ _dynamic_attributes=”button_url” _module_preset=”default” custom_css_main_element=”width: 100%;||text-align: center;” global_colors_info=”{}”][\/et_pb_button][\/et_pb_column][et_pb_column type=”1_3″ _builder_version=”4.21.0″ _module_preset=”default” link_option_url=”#” global_colors_info=”{}” transform_styles__hover_enabled=”on|hover” transform_scale__hover_enabled=”on|hover” transform_translate__hover_enabled=”on|desktop” transform_rotate__hover_enabled=”on|desktop” transform_skew__hover_enabled=”on|desktop” transform_origin__hover_enabled=”on|desktop” transform_scale__hover=”105%|105%”][et_pb_blurb title=” Letha Page, LCSW, MCAP” image=”https:\/\/mmandcc.com\/wp-content\/uploads\/2023\/08\/6F2895A4-0535-4B0A-89F7-A8AFC46F256B.webp” alt=”CC Criollo” _builder_version=”4.22.1″ _module_preset=”default” header_level=”h3″ header_font=”|700|||||||” header_text_color=”#3FA8F4″ border_radii_image=”on|50%|50%|50%|50%” global_colors_info=”{}”]

Therapist<\/em><\/h4>\n
\n
\n
\n

Letha is a Licensed Clinical Social Worker and is a Masters\u2019 level CAP (Certified Addictions Professional).\u00a0\u00a0She is skilled in providing trainings, and counseling services to a diverse cultural population including LGBTQIA+ individuals.<\/span><\/span><\/p>\n<\/div>\n<\/div>\n<\/div>[\/et_pb_blurb][et_pb_button button_url=”@ET-DC@eyJkeW5hbWljIjp0cnVlLCJjb250ZW50IjoicG9zdF9saW5rX3VybF9wYWdlIiwic2V0dGluZ3MiOnsicG9zdF9pZCI6IjEzNzc1OTkifX0=@” button_text=”Read Bio” button_alignment=”center” _builder_version=”4.22.1″ _dynamic_attributes=”button_url” _module_preset=”default” custom_css_main_element=”width: 100%;||text-align: center;” global_colors_info=”{}”][\/et_pb_button][\/et_pb_column][\/et_pb_row][\/et_pb_section]\n","protected":false},"excerpt":{"rendered":"

\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t
\n\t\t\t\t\t

Patient Forms<\/h2><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>Title here Sub-Heading Here Sed ut perspiciatis unde omnis iste natus error sit voluptatem accusantium doloremque laudantium, totam rem aperiam, eaque ipsa quae ab illo inventore veritatis et quasi architecto beatae vitae dicta sunt explicabo.\u00a0Pediatrician I am a board certified pediatrician with 15 plus\u00a0 years of experience and I speak English and Spanish. I offer wellness visits, sports physicals, school physicals, ADHD\u00a0 management, newborn visits, and pre-op exams. I see patients from newborn to 19 years of age.\u00a0Therapist I am a Mental Health Therapist and Life Coach. I have over 10 years of experience and specialize in working with a variety of diagnosis including Attention Deficit Hyperactivity disorder (ADHD), Attention Deficit disorder (ADD), Anxiety, Low-mild Depression, and Family Dynamic\u2019s.Therapist Letha is a Licensed Clinical Social Worker and is a Masters\u2019 level CAP (Certified Addictions Professional).\u00a0\u00a0She is skilled in providing trainings, and counseling services to a diverse cultural population including LGBTQIA+ individuals.<\/p>","protected":false},"author":2,"featured_media":0,"parent":1376786,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-1376784","page","type-page","status-publish","hentry"],"yoast_head":"\nForms - Mindful Medicine and Counseling<\/title>\n<meta name=\"description\" content=\"Pediatric and Mental Health Care Center for Children in Jacksonville | Bi-Lingual Hablamos Espa\u00f1ol | Mindful Medicine Counseling Center\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/mmandcc.com\/es\/patient-services\/forms\/\" \/>\n<meta property=\"og:locale\" content=\"es_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Forms - Mindful Medicine and Counseling\" \/>\n<meta property=\"og:description\" content=\"Pediatric and Mental Health Care Center for Children in Jacksonville | Bi-Lingual Hablamos Espa\u00f1ol | Mindful Medicine Counseling Center\" \/>\n<meta property=\"og:url\" content=\"https:\/\/mmandcc.com\/es\/patient-services\/forms\/\" \/>\n<meta property=\"og:site_name\" content=\"Mindful Medicine and Counseling\" \/>\n<meta property=\"article:modified_time\" content=\"2024-02-01T12:30:50+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Tiempo de lectura\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutos\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/mmandcc.com\\\/patient-services\\\/forms\\\/\",\"url\":\"https:\\\/\\\/mmandcc.com\\\/patient-services\\\/forms\\\/\",\"name\":\"Forms - Mindful Medicine and Counseling\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/mmandcc.com\\\/#website\"},\"datePublished\":\"2023-07-31T17:46:12+00:00\",\"dateModified\":\"2024-02-01T12:30:50+00:00\",\"description\":\"Pediatric and Mental Health Care Center for Children in Jacksonville | Bi-Lingual Hablamos Espa\u00f1ol | Mindful Medicine Counseling Center\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/mmandcc.com\\\/patient-services\\\/forms\\\/#breadcrumb\"},\"inLanguage\":\"es-CO\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/mmandcc.com\\\/patient-services\\\/forms\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/mmandcc.com\\\/patient-services\\\/forms\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/mmandcc.com\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Patient Services\",\"item\":\"https:\\\/\\\/mmandcc.com\\\/patient-services\\\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Forms\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/mmandcc.com\\\/#website\",\"url\":\"https:\\\/\\\/mmandcc.com\\\/\",\"name\":\"Mindful Medicine and Counseling Center\",\"description\":\"Pediatric health care\",\"publisher\":{\"@id\":\"https:\\\/\\\/mmandcc.com\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/mmandcc.com\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"es-CO\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/mmandcc.com\\\/#organization\",\"name\":\"Mindful Medicine and Counseling Center\",\"url\":\"https:\\\/\\\/mmandcc.com\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"es-CO\",\"@id\":\"https:\\\/\\\/mmandcc.com\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/mmandcc.com\\\/wp-content\\\/uploads\\\/2023\\\/06\\\/mmacc-logo-name.svg\",\"contentUrl\":\"https:\\\/\\\/mmandcc.com\\\/wp-content\\\/uploads\\\/2023\\\/06\\\/mmacc-logo-name.svg\",\"width\":929,\"height\":253,\"caption\":\"Mindful Medicine and Counseling Center\"},\"image\":{\"@id\":\"https:\\\/\\\/mmandcc.com\\\/#\\\/schema\\\/logo\\\/image\\\/\"}}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Forms - Mindful Medicine and Counseling","description":"Pediatric and Mental Health Care Center for Children in Jacksonville | Bi-Lingual Hablamos Espa\u00f1ol | Mindful Medicine Counseling Center","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/mmandcc.com\/es\/patient-services\/forms\/","og_locale":"es_ES","og_type":"article","og_title":"Forms - Mindful Medicine and Counseling","og_description":"Pediatric and Mental Health Care Center for Children in Jacksonville | Bi-Lingual Hablamos Espa\u00f1ol | Mindful Medicine Counseling Center","og_url":"https:\/\/mmandcc.com\/es\/patient-services\/forms\/","og_site_name":"Mindful Medicine and Counseling","article_modified_time":"2024-02-01T12:30:50+00:00","twitter_card":"summary_large_image","twitter_misc":{"Tiempo de lectura":"2 minutos"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/mmandcc.com\/patient-services\/forms\/","url":"https:\/\/mmandcc.com\/patient-services\/forms\/","name":"Forms - Mindful Medicine and Counseling","isPartOf":{"@id":"https:\/\/mmandcc.com\/#website"},"datePublished":"2023-07-31T17:46:12+00:00","dateModified":"2024-02-01T12:30:50+00:00","description":"Pediatric and Mental Health Care Center for Children in Jacksonville | Bi-Lingual Hablamos Espa\u00f1ol | Mindful Medicine Counseling Center","breadcrumb":{"@id":"https:\/\/mmandcc.com\/patient-services\/forms\/#breadcrumb"},"inLanguage":"es-CO","potentialAction":[{"@type":"ReadAction","target":["https:\/\/mmandcc.com\/patient-services\/forms\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/mmandcc.com\/patient-services\/forms\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/mmandcc.com\/"},{"@type":"ListItem","position":2,"name":"Patient Services","item":"https:\/\/mmandcc.com\/patient-services\/"},{"@type":"ListItem","position":3,"name":"Forms"}]},{"@type":"WebSite","@id":"https:\/\/mmandcc.com\/#website","url":"https:\/\/mmandcc.com\/","name":"Mindful Medicine and Counseling Center","description":"Pediatric health care","publisher":{"@id":"https:\/\/mmandcc.com\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/mmandcc.com\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"es-CO"},{"@type":"Organization","@id":"https:\/\/mmandcc.com\/#organization","name":"Mindful Medicine and Counseling Center","url":"https:\/\/mmandcc.com\/","logo":{"@type":"ImageObject","inLanguage":"es-CO","@id":"https:\/\/mmandcc.com\/#\/schema\/logo\/image\/","url":"https:\/\/mmandcc.com\/wp-content\/uploads\/2023\/06\/mmacc-logo-name.svg","contentUrl":"https:\/\/mmandcc.com\/wp-content\/uploads\/2023\/06\/mmacc-logo-name.svg","width":929,"height":253,"caption":"Mindful Medicine and Counseling Center"},"image":{"@id":"https:\/\/mmandcc.com\/#\/schema\/logo\/image\/"}}]}},"_links":{"self":[{"href":"https:\/\/mmandcc.com\/es\/wp-json\/wp\/v2\/pages\/1376784","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mmandcc.com\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/mmandcc.com\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/mmandcc.com\/es\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/mmandcc.com\/es\/wp-json\/wp\/v2\/comments?post=1376784"}],"version-history":[{"count":2,"href":"https:\/\/mmandcc.com\/es\/wp-json\/wp\/v2\/pages\/1376784\/revisions"}],"predecessor-version":[{"id":1377981,"href":"https:\/\/mmandcc.com\/es\/wp-json\/wp\/v2\/pages\/1376784\/revisions\/1377981"}],"up":[{"embeddable":true,"href":"https:\/\/mmandcc.com\/es\/wp-json\/wp\/v2\/pages\/1376786"}],"wp:attachment":[{"href":"https:\/\/mmandcc.com\/es\/wp-json\/wp\/v2\/media?parent=1376784"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}