Intake Forms

To get started go ahead and select appropriate intake form below.

Therapy Forms

PATIENT SCREENING INFORMATIONpayment agreementCLIENT counseling CONSENT FORMMental health intake formCREDIT CARD FORM
start therapy intake

Psychiatry / Med Management Forms

PATIENT SCREENING INFORMATIONpayment agreementclient medication refill and consent formControl Substance Agreement FormMental health intake formCREDIT CARD FORM
Start Psychiatry / Med management Intake

Forms can be faxed to (904) 374-3057 or brought in to our office
If you have any questions or concerns, please do not hesitate to contact us at (904) 562-1391

Meet The Clinicians

Dr. Marek Hirsch

Medical Director

Dr. Blazen Draguljic

MD

Corinne Ryan

DNP, PMHNP-BC, APRN

Raluca Harris

MSN, PMHNP-BC
View our Clinicians >