Psychiatric Medication Management Consent and Information Form

  • Nystrom & Associates, Ltd.

    Thank you for choosing Nystrom & Associates, Ltd. for your care. It is important for you to read each item carefully and initial in the space provided to the left each item. By initialing you are indicating you have read, and understand the content of each item. If you have any questions about the items below, please discuss with your provider at your appointment.
  • General:

  • Medication Refill Requests:

  • Appointment Scheduling and Cancellations

  • Forms:

  • Laboratory & Psychological Testing:

  • Billing and Insurance:

  • Genoa Pharmacy:

    We have an on-site pharmacy at our New Brighton and Woodbury locations to provide you with the convenience of filling all of your medications in the privacy of our clinic. However, Genoa can also fill prescriptions for you at all other locations. Genoa can specially pre-package your medication or mail them to your residence, and they will match the pricing of other pharmacies.
  • Date Format: MM slash DD slash YYYY
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