Complete Your Forms Before Your Appointment
To ensure a smooth and efficient visit, we ask all new and existing patients to complete the necessary forms before their scheduled session. Completing these forms ahead of time allows us to better understand your needs and provide you with the best possible care.
Below, you’ll find the most commonly used forms at Zenful Minds, PLLC. If you have any questions about which forms to complete, feel free to contact us for assistance.
New Patient Forms
For all new patients, these forms help us collect essential information about your medical, psychiatric, and medication history:
New Patient Intake Form – Gathers details about your mental health concerns, medical history, and current medications.
Consent for Psychiatric Treatment – Outlines the terms of receiving psychiatric care, medication management, and evaluations at our clinic.
Telepsychiatry Consent Form – Required for all virtual psychiatric care and medication management appointments.
Insurance & Billing Agreement – Details your financial responsibility, accepted insurance plans, and payment policies.
Ongoing Care Forms
For returning patients who need to update records, request medication refills, or provide authorization for new services:
Medication Refill Request Form – For current patients needing a prescription renewal or dosage adjustment.
Progress Update Form – Allows patients to share any changes in symptoms, medication side effects, or treatment response.
Release of Information Form – Authorizes us to share your psychiatric records with other healthcare providers if needed.
Emergency Contact Update Form – Ensures we have the most up-to-date emergency contact information on file.
Specialized Forms
These forms may be required depending on your treatment plan, medication management needs, or specific requests:
HIPAA Privacy Acknowledgment – Confirms your understanding of our privacy and confidentiality practices.
Payment Authorization Form – Allows us to securely process payments for services.
Referral Form – If you have been referred by another provider, this form ensures a seamless transition of care.
Controlled Substance Agreement (if applicable) – Required for patients prescribed certain medications, outlining safe usage and compliance.
Discharge Request Form – For patients who are transitioning out of care and need official documentation.