6 additional WAYS TO FILL OUT FOLLOW-UP FORM 1:
1 Register for a "patient portal" to Dr Di Bella,(click the link) 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.
2. If you have a printer,
Then you could download the pdf
( PDF LINK) form, print out the form, fill it out by hand, then take a cell phone picture of the completed foms 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 murky dark gray), nearly impossible to read.
3 Or, you can download the pdf (form (links above and to the left) 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 PDF 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.
4. You could try marking on the larger version of the form on your cell phone, Both android cell phones and iphone have programs that allow you to mark up photos and forms. You would open up the form on your phone, save, and open for mark up. Then save and send back to us by email.
5. 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.
6.You can request us to mail you the printed paper followup form. Then you can fill out, snap a picture of it, save, and send to our email (or mail in, if 5 days beforehand)
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 a medication, 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 much,
The top half of the form (in the links below) is filled out for all visits after the first time, for all your concerns and issues. Over time you will appreciate that the accuracy of filling these out carefully will reap benefits. The time it takes is well worth it. (5 minutes on average) There are 3 format versions, to be sure you have one that will work on your computer, by printing or cell phone:
FOLLOWUPFORM, PDF version with dropdowns
Followup form RTF version . This will download then you have to open.
FOLLOW UP FORM .PNG VERSION
Geoffrey Di Bella, MD Psychiatrist DBA: OPTILIFE, Inc.
