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Patient Registration Information

What To Expect

Our goal at GAP Clinical Care and Research is to make your experience a positive one. At your first visit, we will spend time reviewing our services and policies before providing you with a thorough assessment. 

You will meet with a licensed clinical social worker or an advanced practice registered nurse who will review your health history and current mental health needs.  You will be assigned a care team that includes an APRN, LCSW and a psychiatrist who will work diligently to meet and address your ongoing psychiatric needs. 

Prior to the end of your first visit, you will have assisted us in establishing an individual plan of care.  In order to accomplish these goals kindly set aside 1.5 hours for your initial visit.

What To Bring

At your initial visit we will need the following items:

  • A photo ID
  • Your insurance card(s)
  • Current list of medications
  • Completed New Patient Information Form
  • Completed Patient Medical History Form
Patient Registration Forms
Medical Records
It is imperative our office receive your medical records prior to your initial visit. Obtaining your records will help our clinicians develop an accurate diagnosis, appropriate treatment plan, and ensures any necessary treatment can be started promptly. To help us obtain your records promptly you can drop off, mail or fax your completed release to our office so we can request records on your behalf or provide the release to your provider’s office and request that they send your medical records to us. If medical records are not received prior to your appointment it may result in a delay in your treatment. | ​Release form

Physician Referral Form

If you are a physician or other health care provider and would like to refer a patient to our office please use the referral form below. Complete and fax this form, along with recent medical records to (203) 288-3655​​. | Referral Form

In addition, please notify the patient that you are referring him/her to our practice. We value your partnership and appreciate the referral.