• Patient Registration Form

    Please Complete
  • If you have never been seen at the Meridian Group before, have not been here for more than 12 months, or have changed insurance plans, please complete this form to request a first appointment. If you do not already have an appointment, you will be contacted by email or telephone within two business days to let you know what is available. All information is confidential. If you have any questions, call our office at 804-751-8644.

  • Primary Health Information

  • Employee Assistance Program (EAP)

    Please complete the following questions if you would like to use EAP benefits (otherwise leave blank). Please note that Compsych EAP is not accepted by any provider and our Psychologists do not accept EAP benefits. Some providers accept EAP, please call our office manager at 804-751-8644 ext 110 to confirm whether your requested provider accepts EAP.
  • Insurance information

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    Please review the following documents:



      • HIPAA Privacy Practices and Policies

     

      • Office Policies and Procedures

     

      • Telemedicine services (if used)

     

     

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  • Thank you for completing this form.  If you already have an appointment, please also complete the Adult Intake Questionnaire (for adults) or Child and Adolescent Intake Questionnaire (parent or guardian for minors 17 years old and younger).  

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