Jason Wexler, MD

NEW PATIENT FORMS

Prior to your first appointment, you will receive an email from Fill containing the Combined Packet of New Patient Forms. Fill is an e-signature service similar to DocuSign. Please use the link in the Fill email to complete this online packet prior to your initial appointment.

If you desire to complete the forms by hand, below is a PDF of the Combined Packet of New Patient Forms (click on link to download):

• Complete Packet of New Patient Forms

For your reference, below is an individualized list of the New Patient Forms
(click on links to download):

• Patient Information

• Patient Brief History

• Medical History

• Release of Health Information

• Release of Health Information (For DC Residents Only)

• Information and Consent Form

• Informed Consent for Telemedicine

• Informed Consent for E-mail Communication (If Desired)

• Card Payment Form

• Medicare Private Contract (For Beneficiaries of Medicare)

A Policies & Fees form can be accessed here.

EDUCATION AND SUPPORT SERVICES

American Psychiatric Association

Maryland Psychiatric Society

National Alliance on Mental Illness

American Foundation for Suicide Prevention

The National Suicide Prevention Lifeline

Anxiety and Depression Association of America

Depression and Bipolar Support Alliance

Attention Deficit Disorder Association

National Eating Disorders Association