New Patient Packet

Printable PDF:

Please download  & print the form below, fill it out and bring it to our office so a friendly staff member can review your details and attend promptly to your case.

Insurances we are in network with:

United Health Care,  United Behavioral Health,  Optum,  Anthem,   Blue Cross,  Blue Shield,  Magellan,  Cigna,  Tri-Care West,  Mental Health Network,  Aetna​

We Are Not Medicare or Medi-Cal Providers

 

© 2019 Premier Psychiatric Services - Mitchell Galerkin M.D., Board Certified Psychiatrist