Welcome to Long Island Behavioral Medicine! On this page are links to some of the basic forms which we ask you to complete before your first appointment. If you are unable to print or complete any of these forms, please arrive at your appointment 15-20 minutes early so that they may be completed before your visit.

New Patient Information Form

HIPPA regulations explanation & Signature Page (Be sure to sign the acknowledgement on page 5)

General Consent for Treatment

Release of Information Form (Only necessary if you are giving an LIBM Practitioner permission to communicate with another person/physician/therapist, etc)

In addition to the general information provided on the above forms, at the bottom of this page are links to a few scales that we ask you to complete before your first appointment. Scales have been developed in psychiatric medicine to help us measure the severity of symptoms in depression, anxiety and other mental health conditions. We’ve specifically chosen these scales because we have found that they may help you to prepare for your visit and to be more able to describe the difficulties you may be facing.

By filling out these scales before your initial visit, we can better learn how you are doing now, and your psychiatrist or therapist may be able to have a more focused, productive discussion when you come for your first appointment. Although it may be easier to print and complete these before you come to your appointment, if you prefer you can arrive 30 minutes before your scheduled appointment and we can provide copies for you to complete at our office.

Be sure to carefully read the instructions for each scale and section. Some scales should be completed based on how you’ve been feeling for the past week, and others are based on a longer period of time. Additionally, we may ask you to complete these forms again at a future appointment to help assess how you are feeling over time. This may also help us to determine the effectiveness of your treatment.

If you would like to print the packet of scales at home and bring them to your appointment:

Patients referred by the World Trade Center Health Program CLICK HERE.
All other adult patients CLICK HERE for our general set of scales.