Patient Forms

Before your first appointment, please complete all of the following forms.  The Patient Information Form and Office Policies Form are available for online submission.  Allow at least 15 minutes to complete the Patient Information Form.  If you prefer to print a PDF and mail it to our office, please mail your forms at least 5 business days before your appointment to allow time for processing. The Document Upload allows you to upload a photo of the front and back of your insurance card and driver's license.  We recommend that you do this on your smartphone.

Patient Information Form

Provide your contact and insurance information, as well as details on your medical history, current concerns and current medications.

or

Office Policies Form

Learn about our office policies and acknowledge receipt of our Privacy Practices.

Document Upload

Upload images/PDFs of your insurance card (front and back) along with the front of your driver's license.  This can be done easily through your smartphone.

© 2020 by Lott Behavioral Health, all rights reserved

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