Reliance Forms

Reliance Patient Forms

The Out-Patient Evaluation Process page is designed to give an overview of the comprehensive patient care system offered by Reliance Clinics. The following information is available to help you understand our approach to your treatment and recovery. Before you will be seen by a healthcare professional please fill out the following forms.

Reliance Medical Out-Patient Forms
Patient Registration Form Part 1- English
Patient Registration Form Part 2- English
Patient Registration Form Part 1- Spanish
Patient Registration Form Part 2- Spanish

Additional Form for Reliance Neuro-psych Out-Patients
Background Questionnaire

Reliance Comprehensive Nero-psych Care Intake
New patients go through a comprehensive intake process. The intake process includes completion of required tests, a detailed clinical interview with a licensed mental health care specialist. Together, the therapist and psychiatrist will help the patient to develop a plan for further diagnostic workups or treatment.

Future Reliance Expert Diagnosis
Reliance neuro-psych care offers a variety of diagnostic procedures to help us reach a deep understanding of our patient’s needs. We are in the process of expanding our diagnostic services with new state-of-the-art equipment such as SPEC, rTMS and a variety of other products.

Treatments Offered by Reliance Neuro-Psych Care
Board certified, our therapists will help meet all your psychiatric needs. We use APA guidelines to treat all our patients.

Follow Up Visits
The Reliance Clinics do follow up treatment for patients who live nearby or who can travel to the clinics on a regular basis.

Patient follow-up varies with individual’s need and situation. The time frame of follow-up visits ranges from once a week to every couple of months, depending on the clinical situation. Some patients, due to insurance coverage, distance or who were referred to us for an opinion by other professionals, continue their treatment elsewhere. When other professionals become involved, the patient may request a copy of the records generated by this Clinic.


Additional Services Coming Soon!

Schedule a consultation for all your medical and mental needs with Reliance Health Clinics.

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