New Patient FormsPrior to Your First Visit

Step 1 of 2: Schedule Your Visit

If you have not already done so, go here and fill out the new patient appointment request form. Once completed, continue to step 2 below.

Step 2 of 2: New Patient Medical History Form

The doctor needs to review your medical history prior to the appointment. Therefore it needs to be completed at least 48 hours prior to your first session otherwise the appointment will be cancelled, $65 will be charged on your credit card and you will have to schedule a second appointment.

Medical History Form
(Complete Online)

Other Forms

Release of Information Form - Use this form to give someone else access to your medical information.


Transcranial Magnetic Stimulation Intake Form - Most insurance companies require prior authorization before you begin TMS therapy, so we've provided a supplemental form that will help us gather the information necessary to get insurance approval.


Child Anxiety Screening - To help us screen a child for anxiety related disorders, we have two forms that should be submitted. One is to be filled out by the child, and the other is to be filled out by the guardian.


ADHD Diagnostic Checklist - This form should be filled out by the guardian.


Helpful Links

Check out these helpful links for more information on many types of mental health issues and prescription drugs.

Click Here


If you have questions about our office or
whether we take your insurance,
give us a call at (843)735-6799.

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