PATIENT INTAKE forms and infoRMATION

FOR NEW PATIENTS:

Before you may be scheduled for an initial telemedicine evaluation visit, we will briefly speak by phone to determine whether or not I am an appropriate psychiatrist to meet your treatment needs, determine whether you have a suitable smart phone with which to engage in video telemedicine visits,  and discuss payment arrangements.  You will need to be able to receive by email, complete, and return to me by fax or email my seven-page New Patient Intake Form.  After I receive your completed form, I will contact you to schedule the initial visit.

FOR  FOLLOWUP VISITS:

Before each visit, please click on the following link and then download the one-page  PREFOLLOWUP OFFICE VISIT QUESTIONNAIRE, print it, complete all questions, and fax or email it to me.  This will ensure that we:  1. don't forget to cover any important issues; 2. don't waste time asking and answering repetitive questions at each visit; 3. utilize the available time more effectively to talk about your particular concerns.  As this form is periodically revised, please download the latest version shortly before your appointment.

FOR ALL PATIENTS:

The following are provided for your reference but do not need to be printed:

HIPAA Privacy Notice

Office Policies

Regarding Electronic Prescribing

Sleep and Mood Log (this may be printed if you wish to use it)

If you need to have information sent to or from Dr. Tobolowsky, the following forms may be downloaded, printed, and completed to enable release of medical information, as indicated:

Authorization form for another doctor or hospital to release information to Dr. Tobolowsky

Authorization form for Dr. Tobolowsky to release information to another doctor

 

Print Print | Sitemap
© David M. Tobolowsky, M. D. - 1&1 IONOS MyWebsite