Patient Forms


How to Become a New Patient

Psychiatry Associates of Tallahassee is currently accepting new patients with Capital Health Plan insurance on a limited basis. All potential new patients are required to complete a new patient intake interview over the phone. The information will be reviewed by the doctor and a determination will be made as to whether or not an appointment at our office will be beneficial for you. To complete this interview, please call us at 850.877.0635, and you will be placed in contact with the intake specialist. Please note that completion of the interview does not guarantee acceptance as a patient.

For Scheduled New Patients

During the COVID-19 public health emergency, there will be some changes to the below new patient procedures. Our office staff will guide you through our new procedures.

If you have scheduled a new appointment, we will contact you to confirm the appointment two business days in advance. We ask that you call us back to verbally confirm the appointment by noon the day before or your scheduled appointment will automatically be cancelled. Please complete and return all new patient paperwork as requested and remember to include your insurance card and a list of current medications.

New Patient Forms

1.) CLICK HERE to access the new patient paperwork if you have an appointment with: Dr. Faisal Munasifi, psychiatrist, Sterling Corry, APRN, George Salama, PA-C, Debra VanGassbeek, APRN, or Theresa Winton, APRN. Please note the last page of this document is a copy of our office polices for you to review and keep.

1.a.) Please CLICK HERE for the OCD test paperwork if you are seeing one of the providers above for possible Obsessive Compulsive Disorder (OCD).

1.b.) Please CLICK HERE for the ADHD test paperwork if you are seeing one of the providers above for possible Attention Deficit Hyperactivity Disorder (ADHD),


2. Speer) CLICK HERE to access the new patient paperwork if you or your child have an appointment with Dr. Connie Speer. Please note the last page of this document is a copy of our office polices for you to review and keep.


3.1 Adult_Reyes) CLICK HERE to access the new patient paperwork for Dr. Lina Reyes if you are over 18 years of age. Please note the last page of this document is a copy of our office polices for you to review and keep.

3.2 Child_Reyes) CLICK HERE to access the new patient paperwork for Dr. Lina Reyes for your child that is under 18 years of age. Please note the last page of this document is a copy of our office polices for you to review and keep.


4.) If your provider asked you to complete the PHQ-9 for depression at a follow up visit, please CLICK HERE.

5.) If your provider asked you to complete the HAM-A for anxiety at a follow up visit, please CLICK HERE.

6.) For a new Release of Information, please CLICK HERE.

CLICK HERE to view a copy of our Notice of Privacy Practices.

CLICK HERE to view instructions for logging in to a Video Chat (Telepsych) session with your provider.

CLICK HERE to see a picture of a cat playing chess.