IMTIAZ RASUL, MDJACKSONVILLE PSYCHIATRIC ASSOCIATION, INC.

Providing Quality Psychiatric Solutions


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Imtiaz Rasul, MD
(904) 379-8748
10175 Fortune Parkway Ste 206
Jacksonville, Florida 32256
info@jaxpsych.org

Helpful Forms


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

  • New Patient Questionnaire
  • Consent for Treatment
  • HIPAA Authorization Form

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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