Appointments
To set up a New Patient visit (adults 18+ only)
1.Please complete the New Patient Online Request Form, then call (512) 964-6992 and press Option 1 to schedule an appointment time.
2.When your appointment has been scheduled, please print out and complete Intake Forms (below) and bring them to your first appointment with your insurance card, ID, medications,and any previous records. We prefer spouses of current patients seek help with another provider to avoid any conflict of interest in case of separation.
3.Please arrive 30-40 minutes early to your appointment to fill out our Intake Forms (if you wish to fill them out at our location), and complete
the Computer Psychological Testing Your providers at CTMH utilize Computer Psychological Testing called AssessMD, which is important in assisting in determining a diagnosis, prognosis and treatment plan. Please see the Computer Psychological Testing Consent (AssessMD) Form below for details..
4.Currently we provide medication management services, not psychotherapy or counseling.
5.Prescribing Philosophy Note: We do not prescribe high dose of stimulants or high dose benzodiazepines, and normally not together at any strength. We also do not typically prescribe benzodiazepines to someone taking opiate pain medications such as hydrocodone, etc.
6.There is a processing fee of $95 per Disability forms and a $25 fee per FMLA leave forms (initial and any subsequent).
Complete Patient Form (9 Forms in 1)
1.Demographics Form
2.Office Policy & Notice of Receipt
3.Notice of Privacy Practices
4.Acknowledgement of Receipt of Notice of Privacy Practices
5.Authorization for Release and Receipt of Information Primarily for Family Members / Personal Reasons
6.Controlled Substances Therapy Agreement
7.Photo Consent Form
8.TD Awareness Screener
9.Optional Questionnaires
10. Telemedicine Informed Consent  
Complete Patient Form Word DOC File Size 2401 KB Complete Patient Form Adobe PDF File Size 2871 KB
Individual Forms
1. Demographics Form 2. Office Policy & Notice of Receipt
Demographics Form Word DOC File Size 433 KB Office Policy & Notice of Receipt Word DOC File Size 44 KB
Demographics Form Adobe PDF File Size 173 KB Office Policy & Notice of Receipt Adobe PDF File Size 127 KB
3. Notice of Privacy Practices 4. Acknowledgement of Receipt of Notice of Privacy Practices
Privacy Practices Word DOC File Size 1170 KB Acknowledgement Receipt Word DOC File Size 197 KB
Privacy Practices Adobe PDF File Size 250 KB Acknowledgement Receipt Adobe PDF File Size 155 KB
5. Authorization for Release and Receipt of Information
Primarily for Family Members / Personal Reasons
6. Controlled Substances Therapy Agreement
Authorization Release Word DOC File Size 294 KB Controlled Substances Therapy Agreement Word DOC File Size 453 KB
Authorization Release Adobe PDF File Size 204 KB Controlled Substances Therapy Agreement Adobe PDF File Size 127 KB
7. Photo Consent Form 8. TD Awareness Screener
Photo Consent Form Word DOC File Size 186 KB TD Awareness Screener Word DOCX File Size 336 KB
Photo Consent Form Adobe PDF File Size 169 KB TD Awareness Screener Adobe PDF File Size 542 KB
9. Optional Questionnaires 10. Telemedicine Informed Consent
Optional Questionnaires Word DOCX File Size 1787 KB Telemedicine Informed Consent Word DOCX File Size 15 KB
Optional Questionnaires Adobe PDF File Size 1812 KB Telemedicine Informed Consent Adobe PDF File Size 244 KB
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