Forms

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Please complete, sign, and e-mail back to Dr. Ambardar the following forms before your first online visit:

(1) New Patient Evaluation Form

(2) Please read our HIPAA Notice and sign the Acknowledgement Of Receipt form.

(3) Office PoliciesPlease read and sign, paying particular attention to the first page regarding Monthly Medication Management Appointments, Late Cancellations, and No Shows.

(4) Treatment Consent FormPlease read and sign.

(5) Credit Card Authorization Form: Please read and sign.

(6) Telepsychiatry & Teletherapy Consent Form: Please read and sign.

Please read about our Medication Refill Policy below before requesting an appointment. Thank you!

 

Office Policy