📍 Garden City, NY
Mon – Fri: 8:00 AM – 6:00 PM
📞 (917) 551-6652
✉️ info@davincihealthcenter.com
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Patient Forms

Complete your intake and assessment forms securely online — before or after your appointment. Each form opens in a new tab and is submitted directly to our care team.

Patient Portal

Complete Your Forms Online

Click any form below to open and fill it out. Forms are powered by Microsoft Forms and submitted securely to Da Vinci Health Center.

New patients: Please complete the Patient Information Form, Confidentiality Agreement, and Consent to Communicate before your first visit. Additional clinical forms may be assigned by your provider.

Intake
Patient Information Form
Personal details, insurance, emergency contact, and medical history. Required for all new patients before their first appointment.
Required · New Patients Fill Out →
Intake
Mental Health Intake & Symptom Assessment Packet
Comprehensive mental health intake covering symptom history, prior treatments, and current concerns. Required for all psychiatric care patients.
Required · Psychiatry Fill Out →
Intake
Patient Acknowledgment Form
Acknowledgment of practice policies, financial responsibilities, and patient rights. Required as part of your new patient paperwork.
Required · New Patients Fill Out →
Assessment
PTSD Intake & Assessment Module (Self-Report)
Self-report evaluation of trauma history, PTSD symptom severity, and functional impairment. Used for diagnosis and treatment planning.
Self-Report · PTSD Fill Out →
Assessment
OCD Assessment & Treatment Module
Evaluates obsessive-compulsive symptoms, rituals, and their impact on daily functioning. Used for OCD diagnosis and treatment planning.
Self-Report · OCD Fill Out →
Assessment
Adult ADHD Intake & Assessment Module (Self-Report)
Standardized self-report tool for evaluating adult ADHD symptoms, attention, impulsivity, and executive functioning challenges.
Self-Report · ADHD Fill Out →
Rating Scale
Hamilton Anxiety Rating Scale (HAM-A)
Clinically validated 14-item scale measuring the severity of anxiety symptoms, including somatic and psychic components.
Clinical Scale · Anxiety Fill Out →
Rating Scale
Patient Health Questionnaire-9 (PHQ-9)
Gold-standard 9-item depression screening tool used to monitor and measure the severity of depressive symptoms over time.
Clinical Scale · Depression Fill Out →
Rating Scale
Hamilton Depression Rating Scale (HDRS)
Clinician-administered rating scale assessing depression severity across mood, anxiety, somatic, and cognitive domains.
Clinical Scale · Depression Fill Out →
Consent & Privacy
Confidentiality Agreement
HIPAA-compliant disclosure outlining how your personal health information is collected, stored, and protected by our practice.
Required · All Patients Fill Out →
Consent & Privacy
Consent to Communicate
Authorization for our team to contact you via phone, text, or email regarding appointments, treatment updates, and billing matters.
Required · All Patients Fill Out →

Have questions about which forms to complete?
Our patient care team is here to help.

Questions? We're Here for You.

Not sure which forms apply to you? Contact our team and we'll walk you through everything. Serving Garden City and all of Long Island.

Contact Us Today →