1910 Crown Park Ct
Columbus, OH 43235
Tel: 614-457-8359
Fax: 614-457-6898
General Hours:
Mon-Thu:
8:30-8:00
Fri:
8:30-5:00
Sat:
8:30-1:00
New Patients: Intake Paperwork
Several forms are available here, for the convenience of our clients. Please click on the links for a PDF file of any necessary paperwork.
If you choose to print and complete any forms, you may bring them in on the date of the scheduled appointment. You may also fax them to our office with a cover sheet indicating: the date and time of the appointment, and the clinician the patient will be seeing.
If you need to download a free version of Adobe Reader, please click the link below to be directed to their webpage.
New patients NOT seeing a psychiatrist, need to choose between the following two forms, depending upon method of payment: insurance, self-pay. There are additional forms required for patients seeing Kevin Hamm or Megan Mottet. See below.
New patients seeing Kevin Hamm have two additional forms to complete: fee policy, DES.
New patients seeing Megan Mottet have an additional packet to complete: under 18, adult.
If you are a new patient for Dr. Blissenbach, just the following form is required: intake.
If you are a new patient for Dr. Schmidt, just the following three forms are required: intake, Schmidt intake, questionnaire.
New BDD clients for Dr. Lilley need ONLY the following two forms: HIPAA, Social Security.
ALL FORMS
HIPAA
Intake
Psychiatrist intake
FAQ SHEETS