Forms

New Patient Intake Form:

We are currently accepting new patients . There may be a wait time of 4 to 6 weeks before we can schedule you with a provider. You may call to confirm that we did receive your paperwork.

The initial appointment is meant to get to know each other, it does not guaranty you will be accepted as a patient.

Please click on the New Patient Packet picture below, print, fill it out and then fax back to our office. (505) 792-6060. Or you can email the filled out forms to: gpmhs@gpmhs.com  Thanks!

New Patient 2019.docx (DOCX — 181 KB)

If you would like for us to fax over medical health records to another provider speak or release information or someone else, please print and fax or mail back the Release of Information Form.

Click here for forms on Release of Information.

 

Referrals from Providers

Please fill out the attachment below and fax it back to us with clinical notes and demographics. If you have any questions please call our office.

The patient can also fill out the questionnaire off the 'Patients' tab and our office will contact them to schedule an appointment. If you would like to have them fill out the evaluation packet and then fax it, they can also download it off the same page.

  • REFERRAL FORM
  • dTMS Provider Referral FORM
  • dTMS Self Referral FORM
  • SPRAVATO Referral FORM