*Please e-mail forms to contact.us@melmedcenter.com or fax them to 480-443-4018*
***ALL TELEMED APPOINTMENTS NEED TO FILL OUT A CONSENT AND RETURN TO US VIA E-MAIL***
| Telehealth Informed Consent |
Follow-up Patient Forms:
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New or Re-Evaluation Patient Packets:
Our goal is to provide you with great care and service. These packets are an IMPORTANT part of our patient registration process.
Please print, thoroughly complete, sign, and bring with you to your appointment.
Please print, thoroughly complete, sign, and bring with you to your appointment.
Includes:
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Includes:
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**We ask all established patients to please print the follow-up forms, thoroughly complete and bring with you to your appointment and make sure to arrive 10 minutes prior to your scheduled appointment.**
Changes/Updates:
If you have a change of address, please complete a Address Change Form, and e-mail it in as soon as possible.
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If you have new insurance plan, please complete a Billing Update Form, and e-mail it in as soon as possible.
| Billing Update Form |
If you have a New Primary Care Physician, please complete a HIPAA Consent for Treatment, and bring to your appointment
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Mood Tracking Forms for Children
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Mood Tracking Forms for Adults
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Psychology Forms
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Teacher Forms
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Consent Forms
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Individual Patient Forms (If Applicable)
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