New Patient Forms
We accept most insurance—and we verify your coverage before your appointment so there are no surprises.
Before Your First Visit
To make your first appointment as efficient as possible, please download and complete the forms below before you arrive.
Print & Hand-Fill
Digital & Email Submission
Fill on Your Device
These forms are required for all new patients. Please complete them before your first appointment.
Basic demographic information, contact details, emergency contact, insurance information.
Current and past medical conditions, surgeries, hospitalizations, allergies, family medical history.
Mental health history, previous diagnoses, past psychiatric treatments, therapy history, family psychiatric history.
Your rights under HIPAA, how we protect your health information, consent to treatment.
Informed consent for psychiatric treatment, understanding of services, patient rights and responsibilities.
Treatment agreement, medication guidelines, program expectations, and follow-up care instructions
What to Bring to Your First Appointment
Required:
- Photo ID (driver's license, state ID, passport)
- Insurance card (front and back)
- Current medications list (or bring the bottles)
- Copay collected at time of visit
Helpful (but not required):
- Recent lab work or medical records (if you have them)
- List of questions or concerns you want to address
- Previous psychiatric records (if applicable)
- List of medications you've tried in the past
How to Complete & Submit Forms
Download Forms
Download all required forms (or use the "Download All" button for a ZIP file with everything).
Download Forms
Fill out all forms completely and accurately. If you're unsure about a question, leave it blank and we'll help you during your appointment.
- Use black or blue ink if completing by hand
- Write legibly
- Don't skip sections — we need complete information
- Call us at 386.308.5088 if you have questions
Bring or Send Forms
- Bring completed forms to your first appointment
- Email completed forms to admin@themaisoncura.com
- Fax completed forms to 386.308.5089
Can't download or open forms?
You may need Adobe Acrobat Reader (free) to open PDF files.
Prefer paper forms?
Call us at 386.308.5088 and we'll mail forms to you, or you can pick them up at our office.
Questions while completing forms?
Call us at 386.308.5088 during office hours (Monday-Friday, 8 AM - 5 PM) and we'll help you.
Accessibility needs?
If you need forms in a different format (large print, different language, etc.), let us know and we'll accommodate.
Ready to Get Started?
Download your forms, complete them before your appointment, and we'll see you soon.