Gagandeep Singh, M. D.
Helping you put the pieces together
DR SINGH PSYCHIATRY
INITIAL VISIT
In order to make an efficient use of your time during our initial session(s), please complete all of the forms from Section 1 AND EITHER the forms from Section 2, if the patient is an adult, OR from Section 3, if the patient is a child/adolescent.
PLEASE COMPLETE ALL OF THE FORMS PRIOR TO THE INITIAL APPOINTMENT
1 ALL PATIENTS
Please complete the following individual forms prior to the initial appointment:
- Demographic Face Sheet (FILL ONLINE)
- Personal History Form (FILL ONLINE) - Some questions may not pertain to children - i.e., caregivers may address school issues for children rather than work history.
- Psychiatric Medication Form (FILL ONLINE) - To be used if there is a history of 4 or greater medications
- Authorization for Release/Exchange of Records (Print & Sign)
- Please read and sign this form to acknowledge receipt of the Notice of Privacy Practices. Read here the full Notice of Privacy Practices before you sign the acknowledgement.
- Please read and sign this form to acknowledge having read and understood the General Policies of my practice. Read here the General Policies of my practice in PDF format before you sign the acknowledgement.
2 ADULT PATIENTS
Please complete the following in addition to the items in Item 1:
3 CHILD/ADOLESCENT PATIENTS
Please complete the following in addition to the items in Item 1:
- REQUIRED: MINORS' MEDICATION CONSENT FORM (Sign & Submit)
- W.H.O. Major Depression Inventory (FILL ONLINE) - To be completed by parents/caregivers and teachers
- SNAP-IV Scale (FILL ONLINE) - To be completed by parents/caregivers and teachers
- SCARED (FILL ONLINE) - To be completed by the child/adolescent (parents/caregivers may assist and may choose to also fill out a copy).
- Mood Disorder Questionnaire (FILL ONLINE) - May be completed by adolescents or by parents/caregivers for younger children
- Parent Mania Rating Scale (FILL ONLINE) - To be completed by parents/caregivers
- Y-BOCS (FILL ONLINE) - May be completed by adolescents or by the parents/caregivers for younger children