Emery & Milne Psychological Group, LLC

River Place Office Park
165 Wells Road, Suite 304

Orange Park, FL 32073

904-720-4040

904-720-4596 (fax)

info@emerymilnepsych.com


Forms

Making it easier 

Forms

If you are a new biofeedback, individual therapy or assessment patient, you will be sent via email/text the appropriate form packet to complete prior to scheduling if you have not yet done so prior to speaking to our intake coordinator. 


To expedite scheduling, please complete the appropriate form packet listed under "New Patients."


If you are seeking a bariatric or spinal cord stimulator psychological evaluation, you will need to complete the packet labeled "Pre-Surgical Evaluation."


All new patient forms are required to be completed prior to scheduling.


All new patients must provide a valid ID and insurance card (except Tricare and VA) when they complete the form packet. 


New Patient Forms 

New Patient Registration Packet Pre-Surgical Evaluation Biofeedback Therapy Sports Performance Social Security Disability VA Disability Evaluation

Existing Patient Forms

Notice of Privacy Practices Patient Experience Survey Release of Information


In order to reduce waste and speed up the check-in process we have moved to complete digital forms. All forms are completed through our secure HIPAA compliant online forms server. 


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