*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 |
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.**
Follow-up Patient Forms:
| Adult Follow-up Forms |
| Child Follow-up Forms |
Changes/Updates:
If you have a change of address, please complete a New Registration Form, and bring to your appointment.
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If you have new insurance plan, please complete a Billing Update Form, and bring to your appointment.
| Billing Update Form |
If you have a New Primary Care Physician, please complete a Contact Update Form, 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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Teacher Forms
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Consent Forms
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Individual Patient Forms (If Applicable)
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