Andrew D. Morrow, M.D.

This form requests basic demographic information, contact information, and any emergency contacts you may have. Please complete the form before arriving for your initial evaluation.

While I do not currently accept any insurance policies, and will not bill your insurance directly, having your insurance information on file will aid me in processing any prior authorizations for treatment or medications that may become necessary for your continued treatment. Please consult your insurance provider regarding their mental health benefits and their policies regarding out-of-network providers.

This form outlines my services, policies and procedures. By law, I am required to have your informed consent in order to treat you. Please review the terms listed in the document, sign them, and bring them with you to your first appointment.

I strongly support your right to privacy. This document outlines in detail my policies regarding the confidentiality of your sensitive health information. Please review it and keep a copy for your records.

By signing this form, you indicate that you have received a copy of the Notice of Privacy Practices listed above.

I am a strong believer that collaboration between health care providers is key to providing effective care to our clients. If you are currently seeing another therapist, primary care physician or other health care professional, and would like us to coordinate care, or you would like me to have records from a previous psychiatrist or hospitalization to aid in forming your treatment plan, please fill out this form. Print and sign one form for each individual or facility to/from whom you would like me to release/obtain medical information.