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New Patient Interest Form
Please fill out this form if you are interested in becoming a new patient of Dr. Helen Yeni-Komshian
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Name
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Email:
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What are you seeking help for?
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Are you interested in medication management, psychotherapy, or both?
Psychotherapy Only
Medication Management Only
Both Psychotherapy and Medication Management
Unsure
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Are you currently on psychiatric medication? If so, which one(s)?
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Who referred you to my practice?
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Do you have any questions about my practice?
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