New Patient Online Paperwork

ALL INSURANCE COPAYS ARE TO BE PAID AT TIME OF SERVICE. All professional services rendered are charged to the patient. Our office will complete the necessary forms to help expedite insurance payments. However, the patient is responsible for all fees regardless of insurance coverage including denied or non-covered services by Medicare, Medicaid and Medicaid Managed Care Plans.

Your complete medication history is important to your physicians. If for some reason you are unable to fill out this form, please bring in a bag all the medications (in their original containers) that you are currently taking.

Check all current positive findings

Over the last 2 weeks, how often have you been bothered by the following symptoms:

At Psychiatric Services, PC, we are committed to treating and using protected health information about you responsibly. Below are listed ways in which your personal information may be used. We ask that you read the following carefully. Please use checkboxes to indicate your permission. Unless otherwise noted, this release will remain in effect until the patient’s treatment is completed. Telephone messages: At times, Psychiatric Services, PC, may need to contact you by phone. We also make appointment reminder calls. Please indicate how you prefer we leave messages for each type of message.