The information on the form must get to the office at least one day before your appointment date. Otherwise we may not be able to have time to process it, and you risk a charge of a late fee of $50 If our follow-up appointment is by video chat, then please see the 6 ways listed below to get in the information without a visit to the office.
6 WAYS TO DO IT;
1. If you have a printer,
Then you could download the pdf (link in the right hand column) form, print out the form, fill it out by hand, take a cell phone picture of it and return by email. (If done this way, please be so kind as to take the photo in a strong light and using your flash... otherwise it all comes out dark gray), nearly impossible to read.
2 Or, you can download the pdf form (link to the right) onto your computer or cell phone. Open, then fill it out with a program that you might have on your computer or cell phone. On the form, there are drop down choices to the right of the 1 2 3 severity choices. Otherwise fill in the areas to fill out. Save, then forward to us by email.
3. You could try marking on the larger version of the form on your cell phone, See the link on ther right side of this page... .png version. Both android cell phones and iphone have programs that allow you to mark up photos and forms. You would open up the .png form on your phone, save, and open for mark up. Then save and send back to us by email.
4. For a $12 charge, on Mon Wed or Fridays, by telephone appointment with our staff, we will mark the form for you, as you confer on the telephone.
5. We provide the printed papere followup form at the end of each visit, in person or by mail. Then you can fill out, snap a picture of it, save, and send to our email (or mail in, if 5 days beforehand)
6. Register for a patient portal with Dr Di Bella,
Patientfusion. (takes less than one minute) After you have an appointment, the program will send you a link to provide the needed information, on your cell or computer. Patientfusion will send us your answers. For all these methods, collect your bottles of medication, so that you can provide information on the number of pills, if any you are taking.
It is not unusual, a person has not been taking, or you are using only, "as needed," and Dr Di Bella needs to be aware of what you have chosen to do.
Thank you so very much,
Geoffrey Di Bella, MD Psychiatrist 
