Patient Portal
(248) 731-7458
Hamzavi Psychiatry and Wellness Center

Hamzavi Psychiatry & Wellness Center, PLLC

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  • Our Services
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Patient Forms

Our Patient Forms

Lighthouse At Sunset — Clinton Twp, MI — Hamzavi Psychiatry and Wellness Center
Consent for Medication ASRS Scale Release of Information Form Credit Card Authorization Form Insurance Information Update Prescription Refill Request Fee Schedule
Psychiatry Intake Form
(only for patients who have contacted the office already)
Therapy Intake Form
(only for patients who have contacted the office already)
Clinic Policies Prescription Policies Telemedicine Consent Notice of Privacy Practices Insurance Benefit Verification Form
Consent for Medication ASRS Scale Release of Information Form Credit Card Authorization Form Insurance Information Update Prescription Refill Request Fee Schedule
Psychiatry Intake Form(only for patients who have contacted the office already) Therapy Intake Form(only for patients who have contacted the office already) Clinic Policies Prescription Policies Telemedicine Consent Notice of Privacy Practices Insurance Benefit Verification Form

Hamzavi Psychiatry & Wellness Center

  • Home
  • Our Clinicians
  • Our Services
  • Patient Forms
  • Careers
  • Testimonials
  • Contact Us
Careers

Phone: (248) 731-7458 | Email: info@hamzavipsychiatry.com | Fax: (248) 973-6068 |

Billing Address: 43151 Dalcoma Drive, Suite 4, Clinton Twp, MI 48038

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