Saadia Alizai-Cowan, MD, FAPA

BOARD CERTIFIED IN GENERAL AND FORENSIC PSYCHIATRY


Forms


If you're a new patient, please complete the following forms.  You may bring them to your first appointment, or preferably scan/email or fax them to me, in advance of the appointment.


If you are covered by Medicare, you must complete the following form acknowledging that you will not submit your invoices for reimbursement.  Please bring this form with your name, address and signature completed.  The effective dates and Dr. Cowan's information can be entered at the time of the appointment.


It is very important for me to have treatment records from former psychiatrists so that you may receive the best possible care.  Ideally, you would complete following release of information form and send to your current/former provider well in advance of our first appointment, asking to have the records sent to me prior to our first meeting.  If you are unable to complete this request before the initial appointment, we will complete it during the appointment.  This form can also be used for your internist, therapist, or other providers.  Please used a separate form for each provider, and download the form that is appropriate for the office you will (primarily) be going to for your appointments.

If you would like to have me keep your credit card information on file, please complete and return the following form:

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