Mental Health Partners, PA
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  • Clinicians
    • John L'Ecuyer, MD
    • Rachael James, APRN, PMHNP-BC
  • Office Policies
  • Forms
    • Patient Forms
  • Education and Crisis Info

FORMS

New Patient Info/Clinical Forms (James)

Follow-up Patient Clinical Form (James)

authorization_form_to_release_or_obtain_your_medical_records__james_.pdf

hipaa_notice_of_privacy_practices__lecuyer_and_james_.pdf

_new__patient_information_form__lecuyer_.pdf

jl--new_patient_telehealth_consent.pdf​
​new_patient_clinical__information_forms__lecuyer_.pdf

authorization_form_to_release_or_obtain_your_medical_records__lecuyer_.pdf

Vanderbilt Child ADHD Parent Form

Vanderbilt Child ADHD Teacher Form

llc--jl--medicare_contract_p_1of3.pdf
​llc--jl--medicare_contract_p_2of3.pdf
​llc--jl--medicare_contract_p_3of3.pdf
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