Patient Forms Download

If you are a new patient, please fill out the following forms* and bring them with you to your first appointment.

• Consent to Release Receive Confidential Info
• Initial History Questionnaire
• Patient's Consent to Treatment Form
• Personal Information Form
• Pharmacy Consent Form
• Patient Treatment Contract (for patients interested in Suboxone Maintenance Therapy)

* Forms are in PDF format. To download a free copy of Adobe Acrobat, click here.

New Patient forms Dr. Jeffrey Simon, MD Psychiatrist: child psychiatry, adolecent psychiatry, suboxone/Vivitrol doctor, addiction medicine and psychiatry