TMS | Behavioral Treatment | Melville
TMS | Behavioral Treatment | Melville
To Schedule An Appointment
Tel: 631-270-4401 Suboxone :631-513-1672
TMS | Behavioral Treatment | Melville
 
Psychiatric Forms
The following forms are for new patients. On each form, please fill out as much as you are able to before your scheduled appointment.

Patient Privacy Consent Form ( For HIPAA Purpose): Click To Download
This form entitles Suffolk Behavioral Medicine to contact the patient’s previous physician, therapist and/or any relatives with the patients consent.

Pre-Visit Evaluation Form

Click To Download
This form is for patient history purposes for a comprehensive evaluation

Insurance Information Form

Click To Download
This form is for new patients or current patients whose insurance may have changed or expired. Please fill this out and bring it to your scheduled appointment

Patient medication consent form for minors (under the age of 18)

Click To Download
This form should be filled out by the legal guardian of the patient

Attendance Policy Form

Click To Download
It is essential that you fill out our attendance policy
 

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NeuroStar TMS Therapy video
 
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