NEW PATIENTS

Prior to your first appointment, please complete the following forms which can be downloaded here:

  1. Demographics and Assignment of Benefits Form
  2. New Patient Questionnaire (3 pages)
  3. PHQ-9 Questionnaire
  4. Patient Information Disclosure Instructions
  5. Acknowledgement of Receipt of Privacy Practices
  6. Professional Services Agreement
  7. Controlled Substance Refill Program: Patient Agreement Form (if applicable)

Please ensure that you arrive at the office at least 10 minutes prior to your appointment time with your completed forms, or 30 minutes prior to your appointment time if you plan to complete forms in the office.

In addition to new patient forms, you should also bring the following items with you to your first appointment:

  1. Insurance card and driver's license.
  2. All medications you are currently taking.
  3. Any medical records which might be useful in your evaluation, including: lab results, psychological testing results, and/or records from your former psychiatrist or other treating physician/NP/PA.
  4. A support person if desired (e.g. spouse, significant other, parent, legal guardian, friend, etc.)
  5. A form of payment (cash, check, Master card, Visa, or Discover card).

Office Photos