If you have any questions about the insurance we accept, please call our office at 786-247-1308.
Find Your Miami Psychiatrist Alternative
By submitting this form, you acknowledge and agree to the following:
The information you provide may constitute Protected Health Information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA). We are committed to protecting your privacy and maintaining the confidentiality of your health information in accordance with federal and state laws.
Information submitted through this form will be used solely for appointment scheduling and initial assessment purposes
Your information may be accessed by authorized healthcare providers and administrative staff involved in your care
We will not share your information with third parties without your written authorization, except as required by law
This form is transmitted through encrypted, HIPAA-compliant technology
Your information is stored on secure servers with restricted access
We maintain physical, electronic, and procedural safeguards to protect your PHI
You have the right to:
Request access to your health information
Request amendments to your health information
Request restrictions on how your information is used or disclosed
File a complaint if you believe your privacy rights have been violated
By providing your contact information, you consent to receive appointment-related communications via the methods you specify (phone, email, or text). You may revoke this consent at any time.
This form is NOT for emergency situations. If you are experiencing a mental health crisis, suicidal thoughts, or any psychiatric emergency, please:
Call 911 immediately
Go to your nearest emergency room
Contact the National Suicide Prevention Lifeline at 988
Call your local crisis intervention team
Submitting this form does not establish a provider-patient relationship. A therapeutic relationship begins only after you have been accepted as a client and have attended your first appointment.
While we strive to respond within one business day, this form should not be used for urgent matters requiring immediate attention. For urgent concerns, please call our office directly.
Although we use secure technology, no method of electronic transmission is 100% secure. By using this form, you acknowledge this inherent risk.
If you are under 18 years of age, a parent or legal guardian must provide consent before we can schedule your appointment.
For questions about this privacy notice or to exercise your rights, please contact:
Office Phone: +1 (786) 247-1308
Email: equilibriummhs@gmail.com
By clicking “Submit” below, you acknowledge that you have read, understood, and agree to these terms and conditions.
