PROVIDERS FOR HEALTHY LIVING
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For New Patients

Information for prospective patients/parents and healthcare
​​professionals
 is found below. 
We are currently providing TELEHEALTH visits (online/virtual visits).  All insurance companies (private and Medicaid) cover these therapy, medication, nutrition, and psychological testing visits with the same cost share (copays, deductibles, or coinsurance) as in-person visits.  These online visits are convenient, safe, effective, and easy to navigate.
Quality, Hope, and Personal Responsibility.
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​​​CLICK HERE to Complete a NEW PATIENT REGISTRATION FORM Today and Get Help Soon!
HEALTHCARE PROFESSIONALS - You may refer your patients directly using the "Professional Referral Form" link below.  We will contact your patient to schedule an initial intake appointment.  We will contact you directly if we have questions or need additional information.
PATIENTS/PARENTS - If you or a family member are interested in becoming a patient in our practice, simply submit the "New Patient Registration Form" below and you will be contacted to schedule an initial intake appointment.
CHILD ADHD EVALS - If your child/adolescent is coming for an ADHD evaluation, it is helpful to have all parents/guardians and all teachers complete Vanderbilt Diagnostic Forms and bring them to the initial intake appointment. These forms are found on the Rating Scales page linked below.
NON-CUSTODIAL OR DIVORCED PARENTS - If you have split custody or need permission from another parent to provide treatment to your child, please have them complete the "Permission to Obtain Medical Treatment Form" below prior to your initial appointment.  Without this form, your child legally cannot be seen by our providers.
EMOTIONAL SUPPORT ANIMALS - It is our policy NOT to provide documentation for emotional support animals.  Writing an ESA letter involves assessing whether an ESA would meaningfully help a patient.  Our mental health providers are not trained to make this determination.  Since we are not trained to assess disability, we cannot certify a client’s claim for disability benefits.  Given this lack of training, writing ESA letters is arguably outside of our scope of practice.
New Patient Forms and Information - Locate the form or page you need then click to access it.
​
  • New Patient Self Registration Form - for patients to refer themselves for services
  • Professional Referral Form - for medical and mental health professionals to refer patients directly
  • Consent for Online/Virtual Mental Health Treatment
  • Contact Preferences Disclosure Form
  • Controlled Substance Agreement - required for all patients receiving stimulants from our office - email completed form to patient@providersforhealthyliving.com after completion
  • Informed Consent for Mental Health Treatment
  • Medical Marijuana Policy
  • Notice of Privacy Practices
  • Numbers to Call in Crisis or to Seek Help
  • Office Policies
  • Patient's Bill of Rights
  • Permission for Minors of Divorced/Separated Parents to Obtain Medical Treatment​ - required for all minors whose parents are divorced or separated - email completed form to patient@providersforhealthyliving.com after completion
  • Rating Scales for Objective Evidence-Based Treatment
  • Release of Information Form - required before records can be sent to or received from another facility or provider - email completed form to patient@providersforhealthyliving.com after completion

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locations:


​Lewis Center - 8351 N. High St, Suite 155, Columbus, OH 43235

​
Maitland - 341 N Maitland Ave, Suite 340, Maitland, FL 32751
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Phone:


614-664-3595 (phone and fax)
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Email:


​Please DO NOT use this email address for medication refill requests or for emergency situations.

Click here for refill requests instead of using email:
Medication Refill Request Form

If you have a medical emergency, email is never the appropriate way to communicate your needs, and you should instead call 911 or go to the nearest ER.  If you are having suicidal thoughts and need to speak to someone immediately, you can contact Suicide Prevention Hotline at the number (and link) below.
​PATIENT@PROVIDERSFORHEALTHYLIVING.COM

​
Communications via email are not secure.  Although it is unlikely, there is a possibility that the information you include in an email can be intercepted and read by other parties besides the person to whom it is addressed.
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2022  |  Providers for Healthy Living  |  All Rights Reserved
  • Home
  • About Us
    • Our Teams
    • Our Locations & Addresses
  • Our Services
  • Virtual Visits
  • For Patients
    • Insurances Accepted
    • Become a New Patient
    • New Patient Information & Forms
    • Current Patient Information & Forms
    • Request a Refill
  • For Professionals
    • Attend or Present an Online Training
    • Refer a Patient
    • Find a Job or Internship
    • Insurance Information
  • Make a Payment
  • Athelas
  • Blog
  • Maitland Florida Office
  • Patient Feedback