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Patient Intake Forms

  • Prior to the first appointment with the provider you must fill out the patient forms.  
  • You must submit a picture of your driver's license (or state-issued identification) and your insurance card to info@premedypllc.com at least 48 hours prior to your initial evaluation.

Consent Form & Policies Questionnaire (pdf)

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New Patient Intake Form Questionnaire (pdf)

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Depression Scale Form (pdf)

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GAD-7 Anxiety Scale Form (pdf)

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Payment Form (pdf)

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