FORMS AND INFORMATION

Please click on the links below to download our new patient forms. Please e-mail or fax them to our office at least 24 hours prior to your appointment.

– NEW PATIENT INFORMATION

– BIOCHEMICAL IMBALANCE SCREENING TEST (BIST)

– CONSENT TO USE TELEMEDICINE TECHNOLOGY

– CONSULTATION REQUEST FORM (for your PCP or primary psychiatric provider to sign)

– CONSULTATION LETTER OF INTRODUCTION (information about Dr. Heermann to share with your PCP or primary psychiatric provider)

– EMAIL CONSENT AND GUIDELINES

– TECHNOLOGY GUIDE

– OFFICE POLICIES AND PROCEDURES

– NOTICE OF PRIVACY PRACTICES

– AUTHORIZATION FOR RELEASE OF CONFIDENTIAL INFORMATION