New Patient Paperwork
To aid me in using our first session as constructively as possible, please submit the following forms electronically prior to the appointment. These forms will be emailed to you directly after you complete the screening form and create your patient portal account.
- Intake Questionnaire
- Practice Policies: which includes Informed Consent to Treatment, HIPAA Privacy Policy, & Payment Policy
- Telehealth Consent
- Authorization for Release of Information
Confidentiality & Privacy Policy
Trust and openness is essential to a strong therapeutic relationship. The law protects the privacy of all communications between a patient and a psychiatrist. I cannot disclose information about you without written permission. See the Notice of Privacy Policy for more details.
The main exceptions to this rule are:
- If you report intentions to harm yourself or someone else
- Suspected child abuse or dependent adult or elder abuse
- If a court orders a release of information
Cancellation Policy
No shows/rescheduling with less than one (1) business day notice: full session charge.
For example, if your appointment is on Monday at 4pm, you will communicate your cancellation no later than Sunday at 4pm; if an appointment is on Tuesday at 10am, you will communicate no later than Monday at 10am.
Emergency & Crisis Situations
If you are experiencing a life-threatening crisis and require immediate assistance, please call 911, or go to the nearest emergency room. If you are feeling overwhelmed are are not in an emergent crisis, you may call the Georgia Crisis and Access Line (GCAL) at 9-8-8.
Synthesis Psychiatry 