Registration & Forms | pbh-behavioral

Registration and Forms

Please open the ‘PBH-Welcome Letter’ below, for further directions on how to submit initial paperwork to our office.

PBH-Welcome Letter

PBH-New Patient Registration

PBH-Office Policies

PBH- Notice of Privacy

PBH-Release of Information

PBH-Medication Consent Form

PBH-Medication Reconciliation Form

PBH-Psychiatric History Questionnaire

Our Staff

Moh Sin Qayyum

Mohsin Qayyum, MD, MBA July 12, 2023 Mohsin Qayyum M.D. MBA is board certified by the American Board of Psychiatry & Neurology in General Adult Psychiatry...

Moh Sin Qayyum

Mohsin Qayyum, MD, MBA July 12, 2023 Mohsin Qayyum M.D. MBA is board certified by the American Board of Psychiatry & Neurology in General Adult Psychiatry...

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ARCHIVES

December 2009
October 2009

PROTECTED HEALTH INFORMATION

Please do not send us any Protected Health Information (PHI), any clinical information, any treatment information or any other transmission that may contain material protected and governed by the Health Insurance and Portability Act (HIPAA) through Email. Please contact us at our office phone number to find out how this type information should be sent to us

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