Please complete these new patient forms before arriving to your initial visit.

 

 When you check in at Pine Bush Mental Health you will be given  a packet of information about our office policies. These forms should be read and signed prior to your appointment. In addition, you will need to fill out a new patient information sheet  and insurance form before your appointment starts. If you like, you can print and fill out these forms in advance, which gives you the opportunity to fill them out at your convenience and bring them with you. Or, if you prefer, you can arrive at your first appointment 15 minutes early to fill out the forms at our office. Please note, Only Dr Timothy Landis' new patients need to fill out the review of systems questionnaire and childhood development form.

new patient face sheet 2016.docx new patient face sheet 2016.docx
Size : 13.618 Kb
Type : docx
financial agreement.pdf financial agreement.pdf
Size : 677.633 Kb
Type : pdf
notice of privacy practices.pdf notice of privacy practices.pdf
Size : 1611.06 Kb
Type : pdf
Review of Systems Questionnaire.pdf Review of Systems Questionnaire.pdf
Size : 91.978 Kb
Type : pdf
Childhood Developmental Form.pdf Childhood Developmental Form.pdf
Size : 171.328 Kb
Type : pdf