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    • Home
    • About
    • What to expect
    • Contact
    • New Patient Forms
    • Ketamine
    • Testimonials
  • Home
  • About
  • What to expect
  • Contact
  • New Patient Forms
  • Ketamine
  • Testimonials

Dear potential new patient,

                                            Welcome  to Contemplative Medicine! 

     When you reach our front desk if we are an appropriate fit you will be given a link to a patient portal. Please complete your demographic information in the portal and the psychometric testing. Upon completing the information in the patient portal, we will need a couple releases signed, the $50 fee, and to make/get a copy of your picture ID and insurance card, if you have one (for prior-authorization purposes). If  you have any questions please call (607)215-1705. 

     Or email frontdesk1@psychiatry.life

Form Downloads

Demographic sheet (pdf)Download
Combined informed consent 2021.docx (pdf)Download
Medical packet p.1 (pdf)Download
Medical packet p.2 (pdf)Download
Medical packet p.3 (pdf)Download
Medical packet p. 4, Mood Disorder (pdf)Download
Medical packet p.5 Dopaminergic signs (pdf)Download
Medical packet p.6 GAD (pdf)Download
Medical packet p.7 ADHD (pdf)Download
Medical Packet p.8 PCL-5 (pdf)Download
Medical Packet p.9 PHQ-p (pdf)Download
Medical packet p.10 MacLean Screening (pdf)Download
  • Home
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Contemplative Psychiatry - Dr. Tara Belsare

(607) 215-1705