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  • axispsychiatry

Phone appointment guidance

Name: Date of Birth:

What symptom (in detail) are you experiencing and when did it/they begin? *How are you experiencing that?

How long do the symptoms last, and does anything improve the symptoms or make them worse?

Any changes in medical history e.g., changes in medicines, new diagnosis?

Changes in appetite and sleep?

Current doses of medications and pharmacy preferred?

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Patient Responsibilities

The care you receive as a patient depends, in part, on your active participation. As your healthcare providers, we believe that you and your family can help us promote the safe delivery of care. These


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