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

Dear potential new patient,

                                            Welcome  to Contemplative Medicine! 

My name is Cara Munck, I am the Office Manager here for Dr Tara Belsare. The  first sheet is demographic information that we use to get you set up into our system. The psychiatric client agreement is yours to look over and keep for your own records, but we do need the last sheet signed and returned. The final packet is the very fun,  medical history and self-assessment packet. Upon return of this screening packet, 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, or want to know/set up a time to complete/set you up with the intake, or anything else, please call (607)215-1705. It can be emailed back to: frontdesk1@psychiatry.life, mailed to 38 Riverside Drive, suite 3, Binghamton,NY 13905 or faxed over to 1-607-203-1668.

Sincerely, 

Cara  Munck

Form Downloads

Demographic sheet (pdf)Download
Combined informed consent for 2021-1 (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


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