Refer a Patient (for providers)

Patient forms and intake documents.

Download and complete your intake paperwork before your first visit. This helps Dr. Rueda's team prepare for your appointment.

Available documents.

New Patient Intake Form

Complete this form before your first appointment. It covers your medical history, current medications, and treatment goals. You may also complete this at the clinic on your first visit.

Download Intake Form (PDF)

HIPAA Privacy Notice

Our HIPAA Notice of Privacy Practices explains how PMC Psychedelic collects, uses, and protects your health information. All patients are asked to review and sign this at their first visit.

Download HIPAA Notice (PDF)

Insurance Verification Authorization

Complete this form to authorize PMC Psychedelic to contact your insurance company on your behalf for coverage verification. Required before Spravato treatment begins.

Download Authorization (PDF)
A PMC Psychedelic team member welcoming a patient at the clinic

What happens when you arrive.

You do not need to submit forms in advance. Our team will walk you through everything at your first appointment. If you'd like to save time, you can download and complete the intake form before arriving.

  • Arrive a few minutes early for your first visit.
  • Bring your insurance card and a photo ID.
  • Bring a list of your current medications.
  • A staff member will review your intake form and answer any questions.
  • Dr. Rueda will conduct your evaluation, in person or via telehealth.

For a full walkthrough of what to expect before, during, and after your first session, visit our What to Expect page .

Have a question about your paperwork?

Call us directly or request a consult and our team will help you prepare for your first visit.

Request a Consult Call 914-928-2913

PMC Psychedelic · Port Chester, NY · 914-928-2913