PBS Psychiatry New Patient Form

New Patient Information

HIPAA Secure
*Completion of this form does not guarantee service at PBS Psychiatry
Demographic Information
Full Name *

First Name Last Name
Date of Birth *

Month Day Year
Date of Birth
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
E-mail *
Insurance Company (we don't accept Medicare or Medicaid products, ) *
Insurance Member ID *
Preferred Pharmacy *
Preferred Pharmacy Phone Number *

Area Code Phone Number
How did you hear about us?

Practice Policy Information
PBS Psychiatry's practice policies and treatment guidelines are provided below, please review the PDF for full details, you can save or print out the PDF as well.
See below for a few key policies that we feel allows for a better understanding of how Better Stories works with people, and how to best achieve your recovery from any mental health struggles:

1. For completion of any short term disability paperwork, FMLA paperwork, school accomodations, patients need to have been seen for at least 90 days, not at the initial visit. All paperwork will completed at an office visit, and require an office visit for completion. We do not perform consultations or court mandated assessments.

2. For your optimized recovery and best quality of life, we require that you are actively engaged in longitudinal psychotherapy with a psychotherapist when you are being treated at Better Stories. There are many struggles that are better suited to psychotherapy treatment rather than medication, and many more that are best treated wih medication and psychotherapy in combination.

2. For any stimulant medication (e.g. ritalin, adderall, vyvanse, concerta) we require a neuropsychological report reflecting an ADD/ADHD diagnosis. If you do not have such a report, please see our list of local clinical psychologists that perform neuropsychological testing to evaluate for these diagnoses and we have collaborated with in the past. Better Stories will not be prescribing stimulant medication until an ADD/ADHD diagnosis is confirmed by neuropsychological testing. Better Stories does not perform neuropsychological testing in our practice.

3. Continuity of care is important to Better Stories, we do not allow patients to switch providers within the practice. If you or your provider feel the working relationship is not a good fit, we will provide you with a list of other providers in the local Pittsburgh area to seek care.

4. We serve the greater southwest Pennsylvania area. If you live more than 60 miles away from Pittsburgh we are not able to manage your care.

5. With the COVID19 pandemic we have added telehealth technology to see patients, and you consent for the engagement of telehealth services, HIPAA secure SMS technology, and reminders (email, secure SMS text, and phone), and our EHR patient portal Patient Fusion, all of which are HIPAA compliant to protect your privacy and ease in your treatment.

6. The first several visits are about therapeutic fit. If you or your provider feel the working relationship is not a good fit, we will provide you with a list of other providers in the local Pittsburgh area to seek care.
Read and Click each key policy that explains how PBS Psychiatry works with people, and how to best achieve your recovery from your mental health struggles: *

1. For completion of any short term disability paperwork, FMLA paperwork, school accomodations, patients need to have been seen for at least 90 days, not at the initial visit. All paperwork will completed at an office visit, and require an office visit for completion. We do not perform consultations or court mandated assessments. 2. For any stimulant medication (e.g. ritalin, adderall, vyvanse, concerta) we require a neuropsychological report reflecting an ADD/ADHD diagnosis. PBS Psychiatry will not be prescribing stimulant medication until an ADD/ADHD diagnosis is confirmed by neuropsychological testing. Better Stories does not perform neuropsychological testing in our practice. 3. Continuity of care is important to Better Stories, we do not allow patients to switch providers within the practice. 4. We serve the greater southeast Pennsylvania area. If you live more than 30 miles away from Philadelphia we are not able to manage your care. 5. With the COVID19 pandemic we have added telehealth technology to see patients, and you consent for the use of telehealth services, HIPAA secure SMS technology, reminders (email, secure SMS text, and phone), and our EHR patient portal Patient Fusion, all of which are HIPAA compliant to protect your privacy and improve communication with your provider. 6. The first several visits are about therapeutic fit. If you or your provider feel the working relationship is not a good fit, we will provide you with a list of other providers in the local Philadephia area to seek care.
Policy Acknowledgement and Consent for Treatment
You are confirming that this form is being completed by the person requesting to be a new patient or the parent or legal guardian of someone less than 18 years of age. All other requests will be rejected and require the person seeking treatment to resubmit a new form with the exception being parents or legal guardians completing the form for children under the age of 18.

This process may take up to 5 business days. Please check your spam folder if you are not seeing that email. We will contact you and provide instructions to set up an appointment for your first visit with us or providing you with contact information on local providers better able to meet your needs.

BY FILLING OUT AND SIGNING THIS SECURE FORM YOU ARE ALLOWING US TO CONTACT YOU BY ENCRYPTED EMAIL (info@dradamtripp.com) OR PHONE (267-996-3765).
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New Patient Information

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Practice Policy Information

Policy Acknowledgement and Consent for Treatment