The Harris Clinic of New York
  • Home
  • About
  • Our Team
  • What We Do
  • Contact
  • FORMS
  • TESTIMONIALS
  • TELE-APPOINTMENTS

Harris Psychiatric services, PLLC
​631-265-1622

New patient forms

New patients: please complete the forms and bring with you to your first appointment 
ENGLISH
new_pt_packet29032018.pdf
File Size: 4822 kb
File Type: pdf
Download File

SPANISH
newpatientpacket-spanish04102018_copy.pdf
File Size: 4932 kb
File Type: pdf
Download File

Authorization to release Information:

If you require exchange of information before your next appointment or if you are no longer receiving treatment at our office, please call 631-265-1622 if you have any questions regarding how to fill out the release forms. Completed forms can be faxed (631-265-3042) or mailed to our Smithtown office for processing.  
Download and complete this form to give us permission to share your protected health information 
release_from_hps.pdf
File Size: 806 kb
File Type: pdf
Download File

Download and complete this form to permit us to receive your protected health information
Download and complete this form to request that we release specific protected health information to you
release_to_hps.pdf
File Size: 807 kb
File Type: pdf
Download File

documentreleasetopatient.docx
File Size: 67 kb
File Type: docx
Download File

Notice of Privacy practices: 

hps_npp.doc
File Size: 111 kb
File Type: doc
Download File

Powered by Create your own unique website with customizable templates.