| 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.
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| 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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Suboxone :631-513-1672 
