First Let's see if you're in the right place... *

I am or will be physically located in Ohio at the time of my appointment(s)

I reviewed the fees and rates on www.apluspsychiatry.com *

I realize that Dr. Levy is out of network with all insurance and I do not have Medicare

I want a thoughtful, down to earth psychiatrist *

I am interested in more than just pills

Who is the prospective patient? *

Myself ( I am the prospective patient)

Someone else

Name of the prospective patient *

First Name

Last Name

Phone number *

(You will have a chance to enter a different number when enrolling as a patient)

(###)

###

####

What are you looking for? *

Diagnostic Evaluation (including ADHD testing)

Second opinion

Medication management

Unsure

Please read this disclaimer carefully *

1. Not a Medical Appointment: This 15-minute phone call is not a medical appointment. It is a brief introductory conversation intended to help you get to know our psychiatrist and discuss the general process of psychiatric care at our facility. 2. No Doctor-Patient Relationship: This phone call does not establish a doctor-patient relationship. It is merely an opportunity for you to learn more about our services and for our psychiatrist to understand your general needs. 3. General Information: During this call, our psychiatrist may provide general information about the types of psychiatric services offered at our facility and answer questions you may have about our practice. However, no specific medical advice or treatment recommendations will be provided during this brief conversation. 4. HIPAA Compliance: Please note that this submission form for scheduling the 15-minute phone call is not HIPAA compliant. While we take measures to protect your privacy and personal information, electronic communications may have inherent security limitations. Do not include sensitive or confidential information in this form. 5. Scheduling Appointments: If, after this phone call, you decide to proceed with psychiatric care, you will be provided an email link to complete the enrollment process so that you can get scheduled with the doctor. 6. Privacy and Confidentiality: We respect your privacy and maintain the confidentiality of all information shared during this call and through the submission form. However, this privacy protection may not be as comprehensive as that provided during formal medical appointments. By requesting and participating in this 15-minute phone call with our psychiatrist, you acknowledge that you have read, understood, and agree to the terms and conditions outlined in this disclaimer. You also understand that this phone call is an initial step in exploring the possibility of psychiatric care and not a substitute for a formal medical consultation. If you have any questions or concerns about this disclaimer or any other aspect of your interaction with our facility, please do not hesitate to contact us at hello@apluspsychiatry.com. We look forward to providing you with the information you need to make an informed decision about your mental health care.

Agree and proceed