FORMS

New-Patients Registration Forms

Please know that your Registration Forms must be completed and Mid Cities Psychiatry must have them at least 24 business hours before your appointment for HIPAA compliance and for your better care.

Please remember.

  • Once your appointment is made, our appointment-team will send you an interactive Registration-Forms’ link for you to complete the forms.
  • You may also download the Registration Forms below, print them, fill them completely, and drop them off at our office at least 24 business hours before your appointment.
  • You may also come to our office to request a blank copy of the Registration Forms to be filled completely, and then to be dropped off at our office at least 24 business hours before your appointment.

If your forms are not completed before the appointment, then our provider may not be able to see you and you’ll be billed $75.00 for a no-show.

Download Our Forms

Registration Form

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Psychiatric Prescriptions Acknowledgement

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Referral Form

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Med
Acknowledgement (ADD)

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Patient Communication
Consent Form

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Med Acknowledgement
(OPIATE MGMT)

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Patient Information

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Licensed Professional
Counselor Form

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Generalized Anxiety Disorder, Alcohol Screening & PatientHealth Questionare

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