NEW PATIENT REGISTRATION
Vitality Psychiatry Group Practice
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  • May use credit card if paying private, request for credit card authorization form
  • Back of credit card if paying private
  • I authorize Vitality to store my credit/debit card information and automatically charge my credit/debit card for payments related to treatment
  • driver or state license, passport, parent's ID
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  • asthma, migraine, hypertension, etc
  • appendectomy, tonsillectomy
  • depression, anxiety, adhd, bipolar, etc
  • opiates, alcohol, cannabis, nicotine, detox and rehabilitation
  • mom-depression, brother-adhd
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