850.205.0189  Fax: 850.329.2903
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New Patient Forms


Links to our forms and documents can be found below:

Notice of Privacy Practices (online form)


Initial Intake Form (online form)


New Patient Paperwork (online form)


Patient Acknowledgement Form - Price Guide (online form)


Permission to Treat Minor (online form)


Permission to Treat Minor for Separate Households (online form)


Credit Card Authorization Form (online form)


Consent to Treatment in the Child and Adolescent Pyschiatry Resident Clinic (online form)


Consent for Treatment by Resident (online form)


Release of Information Authorization Form (online form)


Request to Inspect and Copy Protected Health Information (online form)


Limited Liability Form (online form)


Patient Health Questionnaire (PHQ-9) (online form)


General Anxiety Disorder Questionnaire (GAD-7)
(online form)


Mood Disorder Questionnaire (MDQ) (online form)


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Capital City Psychiatry | 2606 Centennial Place, Tallahassee, FL 32308 | Tel: 850.205.0189 / Fax: 850.329.2903

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