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Date of birth
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Home address
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How did you find Dr. Beard?
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Please list any chronic or serious physical conditions you have:
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Are you pregnant?
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Please list the name, dose and dosing schedule for each medication you take
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Please list any psychiatric medications you have taken in the past
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If you have have family members with psychiatric diagnoses, please list their diagnosis and relationship to you
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Appointments canceled with less than a full business day notice (excluding weekends and holidays) will be charged to your credit card.
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Dr. Beard is opted out of Medicare. Her patients may not file for Medicare reimbursement for her care.
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