YUJUAN CHOY, M.D.

PAPER WORK FOR NEW PATIENTS

Please download and complete the following forms and bring them to your initial appointment. If you have trouble accessing the forms, please inform Dr. Choy and a set of forms can be emailed to you. Completing the forms prior to the appointment will save valuable time and will make the initial appointment much more efficient. If you don't have access to a printer or prefer to complete the forms in person, please plan to arrive 30 minutes before your scheduled appointment time. This will ensure that you have the full session time for the evaluation.

New Patient Appointment Placeholder Form: This form authorizes Dr. Choy to charge a $100 non-refundable appointment placeholder fee to your credit card. The amount charged will be credited towards your initial appointment fee when you show up for the appointment. Should you miss the appointment once your credit card is charged, you will not receive a refund. This form must be provided at time of scheduling in order to hold your appointment time. Click here to download the PDF file.  

Patient Information: This questionnaire provides basic background information about you, your medical history and past psychiatric history. Having this information at hand will expedite the evaluation process. Click here to download the PDF file.

Treatment Consent: This form contains important information on professional services provided, office policies, fee schedule, and other  important information regarding your evaluation and treatment. Please read carefully, initial all pages and sign at end of the document. Dr. Choy will review this consent during the appointment so reading this information beforehand will save valuable time. Click here to download the PDF file

Notice of Privacy Practices: This notice outlines your legal rights regarding your medical information. Please read the Notice before signing the Acknowledgment Form. This form is for your records - you do not need to bring to the appointment. You can also obtain a paper copy of the Notice at the time of the appointment. Click here to download the PDF file  

Acknowledgment Form: This form indicates that you have read and understood the Notice of Privacy Practices, and that you have also read and understood Dr. Choy's cancellation and payment policies (see Office Policies). Click here to download the PDF file

Credit Card Authorization: Dr. Choy will always hold appointment times for you, and in return request that you complete this form. This form authorizes Dr. Choy to bill your credit card for services and missed sessions. Click here to download the PDF file.

Anxiety and Depression Screening Questionnaires: Standardized self-rating scales are helpful tools to identify presence of anxiety and depressive symptoms, and will provide additional information during the initial evaluation.  Please click on the following questionnaires to download the forms and complete them on the day of your visit: GAD-7, PhQ-9 and GADQ-IV

Release of Information Form: If you have prior medical records that may be important for your evaluation or treatment, or you have a therapist or physician with whom Dr. Choy can contact and coordinate your care, please fill out the form which will give Dr. Choy permission to contact the persons or agencies listed. Click here to download the PDF file