Julie Ryder, PMHNP
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CURRENTLY NOT ACCEPTING NEW PATIENTS

NEW PATIENT QUESTIONNAIRE 

Please download, print and complete the new patient questionnaire prior to our first visit.  This will allow you the opportunity to take your time filling out the forms at your convenience.  Also ensuring you have not left any information out.  Please include a copy of your Insurance card(s) when returning the New Patient Questionnaire.  The Receptionist can make a copy for you, if needed.  

New Patient Questionnaire Forms
Adult Form:

adult_new_patient.pdf
File Size: 932 kb
File Type: pdf
Download File

Child Form:

child_new_patient.pdf
File Size: 443 kb
File Type: pdf
Download File

Release of Infomration (HIPPA)
Use this form if we are getting records from other providers. Fill out one form for each provider. 

roi.pdf
File Size: 473 kb
File Type: pdf
Download File

LETTER TO NEW PATIENTS

This letter will help you understand my office procedures, policies, what you can expect from me, and your responsibilities to my office. 

Letter to New Patients:

julie_lettertonewpatients.pdf
File Size: 191 kb
File Type: pdf
Download File

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