Breadcrumbs

Important Forms for New Patients


Please take time to complete the forms below and bring them with you to your first visit. Completing them in advance will save you time at your initial visit.

Patient Demographic Information/Registration Form
This form collects all the necessary personal information for new patients

Patient Medical History Form
This form collects information on your medical history that is important to your physician in decision-making, formulating a diagnosis and providing the right medical care for you.

Notice of Privacy Practices / Aviso De Prácticas De Privacidad
This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

Initial Screening - Children and Adolescents
This form is used for the initial psychiatry screening for children and adolescents.

Initial Screening - Adult
This form is used for the initial psychiatry screening of adult patients.

Notice of Collection of Patient Social Security Number
This form describes the purposes for which your social security number is collected, used, and/or shared and how it is protected.

Notice of Social Security Number Collection and Use
This form acknowledges that you have received information on the purposes for the collection, use, or release of your social security number.

General Consent Form

Medical Records Request form