If you would like us to release any aspect of your personal health information from your medical records to another doctor or therapist, family member or organization, please complete our HIPAA authorization form, sign it, and drop it off at our office or return it by fax or email.

We’ll also use this HIPAA form to obtain your medical records from another doctor, therapist, lab, or hospital.

If it’s easier for you (and who isn’t into easy?), we can email you our HIPAA release form so that you can just type into it online, sign it with your finger or a stylus and send it right back to us by email.  Let us know if you’d like us to do that here.

We’ll make every attempt to respond to your request within 30 days.


HIPAA Authorization

Notice of Privacy Practices



If you’re an established patient within our practice, you’re in for a treat. We value your time and want to cut down on your commute. So we offer Telepsychiatry.

If you’d like to request to be followed, in part, with appointments by phone, FaceTime, or video, please let use know here and complete our consent form or ask us to send you one that you can sign online and shoot back to us:

Telemedecine Consent Form


Mood Chart

It’s often helpful to keep track of symptoms and response to treatment in an organized, visual way by using a daily mood chart. We offer paper and digital mood charts.  Our paper version was originally designed by my colleague, Gary Sachs MD of Massachusetts General Hospital, and adapted for our practice.

Daily Mood Chart

We offer digital mood charting and mood tracking for our ketamine patients.  It’s a fantastic way for us both to follow how you’re doing with beautiful graphs and charts.

Quick Inventory of Depressive Symptomatology (QIDS SR-16)

The QIDS SR-16 is a self-report measure of depression.



Mood Disorder Questionnaire (MDQ)

The Mood Disorder Questionnaire (MDQ) was developed by a team of psychiatrists, researchers and consumer advocates to address the need for timely and accurate evaluation of bipolar disorder.

Mood Disorder Questionnaire


Altman Self-Rating Mania Scale (ASRM)

The ASRM is a 5-item self-rating mania scale, designed to screen for the presence and/or severity of manic symptoms.

Altman Mania Scale


Zung Self-Rating Anxiety Scale (SAS)

The Zung SAS is a self report measure for anxiety symptoms. Just place a check in the column which best describes how often you felt or behaved this way during the past several days.

Zung Anxiety Scale


Symptoms of PTSD (PCL-5)

The PCL-5 is a 20-item self-report measure that assesses the 20 DSM-5 symptoms of PTSD. The PCL-5 is used for:

  • Screening individuals for PTSD
  • Making a provisional PTSD diagnosis
  • Monitoring symptoms changes during and after treatment

The gold standard for diagnosing PTSD is a structured clinical interview such as the Clinician-Administered PTSD Scale (CAPS-5).

Symptoms of PTSD


Yale-Brown Obsessive Compulsive Scale (Y-BOCS)

The Y-BOCS is used to help understand how severe your Obsessive Compulsive Disorder (OCD) may be.

Yale-Brown OCD Scale


Drug Abuse Screening Test (DAST-10)

The following questions concern information about your possible involvement with drugs not including alcoholic beverages during the past 12 months.

Drug Abuse Screening Test


Short Form McGill Pain Questionnaire 2 (SF-MPQ-2)

The SF-MPQ-2 allows you to rate the intensity of each of the pain and related symptoms you felt during the past week on 0 to 10 scale, with 0 being no pain and 10 being the worst pain you can imagine. Use 0 if the word does not describe your pain or related symptoms.

McGill Pain Questionnaire


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