Patient Forms

Important Forms

• New Patient Intake New patient registration and intake questionnaire only — not for existing patients.
• Prescription Refill Request Request a refill for your current psychiatric medication.
• Follow-Up Appointment Request Request a follow-up appointment (existing patients only).
• General Inquiry Send a message to our office. Choose what your enquiry is for below.

All forms

These open the General Inquiry form with your enquiry type already selected.

• Medical Records Request Request copies of medical records.
• Medication Question Ask a non-urgent question about your medication.
• Prior Authorization Submit information needed for insurance prior authorization.
• Provider Referral Refer a patient to our practice.
• Appointment Cancellation Cancel an upcoming appointment.
• Patient Portal Help Get help accessing the patient portal.
• Billing Question Ask a question about billing or insurance.
• Lab Results Follow-Up Request follow-up regarding lab results.
• Therapy Referral Request Request a referral to outpatient therapy.
• Disability Paperwork Request disability-related documentation.
• FMLA Paperwork Request FMLA-related documentation.
• Release of Information Authorize release of medical information.
• Contact Information Update Update your phone, email, or address on file.
• Emergency Contact Update Update your emergency contact information.
• Consent for Follow-Up Provide consent for follow-up communications.
• Patient Feedback Share feedback about your care experience.