Patient Forms

If you are a NEW PATIENT and have a scheduled appointment, please download, print and complete the forms required by your provider and bring them to your scheduled appointment.

Completion of all applicable forms is necessary for your first scheduled visit with your provider, Failure to complete forms before your scheduled appointment time will result in your appointment being rescheduled.

At the time of your appointment, you are required to present a copy of your drivers license and all insurance cards. Failure to do so will make you responsible for paying for your visit in full.

PSYCHIATRISTS

• David Buttross III, MD
• Jayendra Patel, MD

MENTAL HEALTH NURSE PRACTITIONERS

• Michelle Dyer, APRN, APMHPN
• Erica Hessifer, APRN, FPMHNP
• Bethanne Carson, APRN, APMNHP
• Candyce Brown, APRN, FPMHNP

CLINICAL SOCIAL WORKERS

• Robbi Dowden, LCSW, ACSW
• Ann Kern, LCSW, ACSW, BCD
• Russell V. Richard, LCSW

Counselors

• Cindy Nassar, LPC, LMFT