Patient Forms

Please click on the form you wish to download from the list below.

Complete Patient Packet Online (for new patients only)

Download and Print Patient Packet

1. Adult Packet

2. Minor Packet

3. Paquete Para Adultos

4. Paquete Para Menores

please email the completed forms to care@inlandpsych.com or submit them in office prior to appointment. Please contact us for any questions

Other Forms

1. Release Form

2. OCD Screener

3. Adult ADHD

4. Telemedicine Consent Form

5. HIPAA Notice of Privacy Practices

6. Right of Access Form for Friends & Family

please email the completed forms to care@inlandpsych.com or submit them in office prior to appointment. Please contact us for any questions

Patient Forms

Please click on the form you wish to download from the list below.

Complete Patient Packet Online

Download and Print Patient Packet

1. Adult Packet

2. Minor Packet

3. Paquete Para Adultos

4. Paquete Para Menores

please email the completed forms to care@inlandpsych.com or submit them in office prior to appointment. Please contact us for any questions

Other Forms

1. Release Form

2. OCD Screener

3. Adult ADHD

4. Telemedicine Consent Form

5. HIPAA Notice of Privacy Practices

6. Right of Access Form for Friends & Family

please email the completed forms to care@inlandpsych.com or submit them in office prior to appointment. Please contact us for any questions

Pay Bill

Pay Bill

Patient Forms

Complete Patient Packet Online (for new patients only)

Download and Print Patient Packet

1. Adult Packet

2. Minor Packet

3. Paquete Para Adultos

4. Paquete Para Menores

Other Forms

1. Release Form

2. OCD Screener

3. Adult ADHD

4. Telemedicine Consent Form

5. HIPAA Notice of Privacy Practices

6. Right of Access Form for Friends & Family

Patient Forms

Complete Patient Packet Online

Download and Print Patient Packet

1. Adult Packet

2. Minor Packet

3. Paquete Para Adultos

4. Paquete Para Menores

Other Forms

1. Release Form

2. OCD Screener

3. Adult ADHD

4. Telemedicine Consent Form

5. HIPAA Notice of Privacy Practices

6. Right of Access Form for Friends & Family

John Kohut, MD

Practicing locations :

John Kohut, MD

Practicing locations :

Sigrid Formantes, MD

Practicing locations :

Sigrid Formantes, MD

Practicing locations :

Benefit the rewards of being a part of our Mental Health Group Therapy.

Benefit the rewards of being a part of our Mental Health Group Therapy.

Telepsych ensures you get better access to healthcare with a decreased wait time.