Cornerstone Psychiatric Services, Inc.

1790 E. Venice Ave. Ste. 204
Venice, FL 34292

Phone: (941) 488-8884

Fax: (941) 488-5554

Medical Records Fax:

(941) 375-0119

New Patient Registration Steps

1) Read Welcome Letter and check insurance plans we accept

2) Complete Online Authorization to Use and Disclose (Medical Records Release of Information) Form

3) Complete Online New Patient Registration Form

You must follow ALL 3 steps before we will call you to schedule the appointment. If you do not hear from us within 2-3 business days, please contact our office as there maybe some missing items from your registration.

* Notice * READ THIS BELOW FIRST ***

Age Limit: our practice only accepts patients 18 years of age and older
Our providers DO NOT prescribe or manage Suboxone (buprenorphine and naloxone) or Clozoril (clozapine)
Our practice does not accept cases related to: workers compensation, auto accident, personal injury, court order psychiatric evaluations or pre-surgical psychiatric evaluations.

STEP 1

⇦⇦ Click on the Welcome Letter image to read

THIS STEP IS JUST A REVIEW OF TWO DOCUMENTS:

1) Welcome Letter

2) List of Insurance plans we are in-network or out-of-network. Click the button below to review the insurance plans and if we are accepting new patients with your insurance plan.

Also, call your Primary Care Provider (PCP) or current mental health provider and have them fax us a new patient referral to 941-375-0119. Your insurance may not require it, but we are requesting this please.

Review Insurance Plans

Step 2

Online Form -Authorization to Use and Disclose of Information

Medical Records Release of Information (ROI) Form

All new patients, we suggest and encourage you to complete this form for your Primary Care Physician (PCP) and your previous mental health provider(s). One form per provider. Complete additional Online forms to include your spouse or any individual(s) you allow to be able to call our office and ask/discuss information relating to your appointments, prescriptions and treatment.

Step 2: Complete ROI Form Now

Step 3 - FINAL STEP

Online Form - New Patient Registration

Please prepare yourself by taking photos or scanning your photo ID and all insurance cards (front & back sides). You will be able to upload your ID and insurance cards directly into this online form.

Step 3: New Patient Registration Complete Now

or alternate option: New Patient Paper Form

Only complete paper form if you did not complete the on-line version above.

If you are not able to to complete the Online version then download New Patient Registration Form and write in your responses. Return your completed form to our office by using the Upload Document feature on our website, mail back to us or drop off at our office.

Download Paper Form for New Patient Registration

New Patient Registration form is required for all new patients and patients that have not been seen 3 or more years ago. Complete preferred method of the Online form -OR- you can download the 'Paper Form' and write in your responses.

Benefits of the Online Form: you have the ability to upload documents such as photo id, insurance card (front and back side), prescription drug benefit card, most recent lab results, medication list and other documents. We also receive your information immediately after you submit your form.

Welcome Letter
Welcome to Cornerstone letter v01.26.pdf
Adobe Acrobat document [281.0 KB]

New Patient Registration Paper Form
Patient Registrationv0126.pdf
Adobe Acrobat document [284.9 KB]

The following 3 forms are for you to review and keep for reference:

Patient Rights and Responsibilities
Notice of Privacy Practices
Office Policies

Patien Rights and Responsibilities
Patient Rights and Responsibilities Form[...]
Adobe Acrobat document [17.6 KB]

Notice of Privacy
NoticeofPrivacy-v0318.pdf
Adobe Acrobat document [2.7 MB]

Cornerstone Office Policies
Office Policies-v0126.pdf
Adobe Acrobat document [110.6 KB]

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