Psychiatric Counseling Information Packet & Questionnaire for Patients

 

Prior to your first appointment, please print out the New Patient Packet of forms (see below), fill them out and sign them, and bring them to our appointment.

There is also a Questionnare Packet below that you may print, answer and bring to our appointment if any of them seem relevant to you, or if you and I discuss that it would be helpful for you to do so.

 


 

Adobe Acrobat PDF File Arbitration (9K) - Arbitration Agreement

Adobe Acrobat PDF File AuthforRel (10K) - Authorization for Release

Adobe Acrobat PDF File Billing Information (29K)

Adobe Acrobat PDF File Email Consent (11K)

Adobe Acrobat PDF File HIPAA (94K) - HIPAA Notice

Adobe Acrobat PDF File Map to Office (12K) - Map to Office

Adobe Acrobat PDF File Medical History (93K)

Adobe Acrobat PDF File MedPolicy (8K) - Medication Policy

Adobe Acrobat PDF File New Patient Packet (347K)

Adobe Acrobat PDF File PersonalInfoSheet (7K) - Personal Information Sheet

Adobe Acrobat PDF File PersonalInfoSheetMinor (7K) - Personal Information Sheet - Minor-fill out if patient is a minor

Adobe Acrobat PDF File Privacy Contact Information (7K)

Adobe Acrobat PDF File Questionnaire Packet (1MB)

 

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