Helpful Forms

If you're a new patient, please complete the following forms and bring them to your first session.

If you would like me to coordinate care with another provider (for example, primary care physician, etc.), complete this form to authorize release of your psychiatric information:

Release of Medical Records Form

Note: To download Adobe Acrobat Reader for free, click here.

Jacksonville Psychiatric Association, Inc. provides psychiatric evaluation and treatment specializing in Bipolar Disorder, Anxiety Disorders, Post Traumatic Stress Disorder, Obsessive Compulsive Disorder, Suicidal Thoughts, Attention Deficit Disorder, Attention Deficit Hyperactivity Disorder, Aspergers Syndrome, Mood Disorder, Suboxone Treatment, Depression Help, Anxiety Help, Learning Disorders, ADD Testing, ADHD Testing, Generalized Anxiety, and PTSD Counseling

Proudly Serving: Jacksonville, St Augustine, Orange Park, St Johns, Fruit Cove

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Jacksonville Psychiatric Association, Inc. and TherapySites expressly disclaim all warranties and responsibilities of any kind, whether express or implied, for the accuracy or reliability of the content of any information contained in this site, and for the suitability, results, effectiveness or fitness for any particular purpose of the content. You are solely responsible for your use or reliance on such information and any foreseeable or unforeseeable consequences arising out of such use or reliance. In no event will Terry Thayer or TherapySites be liable for any damages resulting from the use of or inability to use, the content, whether based on warranty, contract, tort or other legal theory, and whether or not Terry Thayer or TherapySites is advised of the possibility of such damages. In no event will Terry Thayer's and TherapySites's aggregate liability exceed U.S. $100.

Disclaimer

IMTIAZ RASUL, MDJACKSONVILLE PSYCHIATRIC ASSOCIATION, INC.

Providing Quality Psychiatric Solutions

Helpful Forms