Forms

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If you are a new Psychiatry or Psychotherapy patient, please complete, sign, and e-mail back to Dr. Ambardar the following forms before your first online visit. If you are a new Coaching client, Dr. Ambardar will e-mail you a separate set of intake forms.

(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, paying particular attention to the OTHER PROFESSIONAL SERVICES section as excerpted here:

Professional services such as completing prior authorizations for medications, ordering medications outside of regularly scheduled appointments, filling out forms, telephone calls, extensive e-mail conversations, preparation of treatment summaries, or time spent performing any other functions that you may request will be charged $150 for each 15 minute increment.

(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 a Psychiatry appointment. Thank you!

 

Office Policy