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WEB New Patient - Getting Started - Telepsychiatry

Getting Started Page One

I am really glad that you are interested in my practice of telepsychiatry. If you fill out this form I can answer any questions that you might have. All of the information that you share is completely confidential. 

 

The completed form will be emailed to a clinician at Gateway. As with all electronic communications, email is inherently insecure. If you want to guarantee the security of your message, please install a secure email service, like Virtru, and email our office manager directly at hershe@gatewaypsychiatric.com.
This question requires a valid email address.
How do you prefer to be contacted? *This question is required.Email is usually much quicker.
Dr. Forster provides telepsychiatry services if -

  1. You pay for services prior to the appointment with a credit card.
  2. You agree that you do not need a controlled substance prescription; or are willing to have one visit with Dr. Forster in person; or you have a primary care doctor who is willing to prescribe these medications based on Dr. Forster's recommendations.
  3. You are not in crisis or in need of emergency care.
  4. You do not have Medicare. 
  5. You have a local friend or relative, or health care provider, who can be available to Dr. Forster in the event of a crisis or need for immediate intervention.
  6. You have access to a computer with a broadband internet connection and agree to download the HIPAA compliant software that makes these sessions possible. 
1. Please check all answers that are true.  *This question is required.
Thank you for agreeing to the conditions of treatment.