Header Image

NEW PATIENTS START HERE

PREPARING FOR YOUR FIRST VISIT

1 . PLAN TIME ACCORDINGLY- Plan for one hour for your first visit. The first appointment is the longest due to collecting data, assessment, and evaluation of your condition. You will receive an invite and link via email just prior to your appointment to enter the Telemedicine session. Our Telemedicine platform is ZOOM please make certain you have it downloaded. Please avoid distractions during appointment (family members, cell phones, etc.).

2. FAX COPY OF RECENT EXAM-  Indiana Telemedicine law requires a new patient to receive an in-person exam by a licensed health care provider (Physician/Nurse Practitioner) prior to receiving medication and exam can be with provider other than prescribing provider. Contact our office via email to receive further details (info@jadamsandassociates.com). 

3. COMPLETE FORMS- Complete all necessary forms - see "Required Forms." There are Four (4) forms to electronically sign and submit online and two (2) forms (Patient History Data Form and Financial Agreement) to print, complete and return to us via fax (219-315-0255) or scan and email. Once you make your appointment you will receive an email which will include the financial agreement. NOTE: Neither the Patient History Data Form or the Financial Agreement can be completed online. Both forms must be printed first then completed. 

4. PAYMENT- All patients are required to keep an updated credit/debit card on file when they register for an account. Anthem Blue Cross Blue Shield Patients are responsible for paying co-payment. Patients with other insurance pay in full and file their own claim to insurance for reimbursement. You will receive a receipt when your appointment is completed and payment is received. 

5. CURRENT MEDICATIONS- If you have been on several psychiatric medications in the past and can't remember the names, please obtain a list from your pharmacy and note this information on the Patient History Data Form under "Medications."

6. PRIOR RECORDS- Fax or email labs (within the past 3 months)- you may obtain this from your primary care provider/physician.

7. LEGAL GUARDIAN- If the appointment is for a child under the age of 18, the primary parent and/or legal guardian (primary caregiver) must be present during all visits unless otherwise specified.

8. PREPARE COMPUTER/TABLET/CELL PHONE- .Remember to have your devise charged and ready to go before your appontment. Please make certain the lighting and sound are appropriate. 

9. REVIEW FREQUENTLY ASKED QUESTIONSMany patients report this is very helpful in answering many of their questions. 

10. Look forward to a relaxed and comfortable visit and be on your way to feeling great again!

CHECKLIST FOR FORMS TO SUBMIT ONLINE

1. Late Cancel No Show _____
2. Fee and Payment _____
3. HIPPA Privacy _____
4. Consent for Treatment _____

 
CHECKLIST FOR FORMS TO EMAIL OR FAX

1. Patient History Data Form _____
2. Financial Agreement  _____
3. Copy of Insurance Card _____
4. Copy of Drivers License _____

 
* We realize gathering all information before your first visit requires time, and we thank you in advance.  At Psychiatric, Health & Wellness, we want to do our best in serving you!

We look forward to meeting you!

(For your convenience, you may print this form)
Download and Print this form.