Medical Records forms:
· NPI Records Request: Request that your NPI records be released to outside person or facility.
· Request for Form Completion or Letter: Request for provider to write a letter or complete a form (i.e.: FMLA, disability).
· Records Release form: Request that your records from another provider be sent to NPI
New Patient forms:
The medical provider cannot see you if intake forms are not completed and ready before the appointment.
New Patients will receive a link to intake forms when the appointment is scheduled. The link will be at the end of the text/email of the appointment confirmation message. To begin registration, first press the "Confirm" button, and you will then be presented with an option to Begin Registration. Please assure you have a few minutes of uninterrupted time before beginning, as the registration will take at least ten minutes to complete.
Please note: additional reminders will go out one week before and two days before your appointment. If you have already completed and submitted your registration, do not complete it again. You may call the office to confirm receipt of the intake forms.
***IMPORTANT - NEW PATIENTS, PLEASE READ ALL INFORMATION BELOW***
You should expect to be in our office for a total of about 1.5 to 2 hours for your first appointment. Upon arrival we wlll collect your picture ID and insurance cards to scan into the computer. In addition to the intake completed online, you may be given Screening Questionnaires to complete***. You will then be sent to a staff member to complete registration, which includes: verification of demographic information, photo of patient for the electronic chart, explanation of insurance benefits (based on what we were quoted by your insurance company), and collection of any payment due. You may also be taken by a medical assistant to take your vitals ( ie: height, weight, temperature, blood pressure). You will then be ready for evaluation, which should take about one hour, face to face with our clinical staff member.
***Minor CHILDREN must be accompanied by a (biological) parent or legal guardian ONLY. Otherwise, you must provide written legal documentation showing that you have the right to consent to the child’s psychiatric treatment. Florida Statute: 743.0645(1)(c). If the patient is a certified "unaccompanied homeless youth" under Florida Statute: 743.067, then patient may receive only psychotherapy services, with proper documentation.
A power of attorney or notarized note is NOT sufficient for a child's mental health evaluation or treatment.
If you are unable to complete the intake online and have a printer at home, you may print the forms below.
· Medical History Form: Print and fill out at home (This form has 8 pages)
-Combined Patient Information and Consents - Print and sign at home and bring to office
· HIPAA Records Compliance Form -You may read the Notice of Information Practices referred to in the HIPAA Records Compliance form by clicking the following link: Notice of Information Practices
Forms above must be complete before your appointment. The medical provider cannot see you if the forms are not completely filled out and ready for the evaluation.