Offices in Legacy Plano, Plano and McKinney

Patient Forms

Patients are required to complete and submit the applicable forms below prior to
their scheduled appointment time, or the appointment may be rescheduled.

IMPORTANT

Psychiatric Care Forms

  • Do not complete these forms more than 7 days in advance of your appointment.
  • These forms must be completed online; they cannot be accessed from a cell phone or printed out and filled in. When you arrive at our office for your appointment you may request a printed copy for your records.
  • Please avoid closing your browser window until the final submission of the data is complete. If you accidentally close your browser window before finishing you will need to come to our office and complete the forms prior to your appointment.

Psychiatric Care Forms

These forms must be completed online. Completed forms are submitted electronically and privately to your doctor. Please read all the requirements above before you begin.

Psychiatric Care - New Patient Form

Chevelle Brudey M.D., Alipio Mascarenhas M.D., Dan Steinfink M.D., Nancy Donachie M.D, Vernon Charles Johnson, M.D., David Crumpacker M.D., Sara Jaquay MSN, PMHNP, Laura Slaughter M.D., Roland Tsopze Nurse Practitioner, Vernon Charles Johnson, M.D., Charukesi Chandrasekaran M.D.

Psychiatric Care - Follow Up Form

Chevelle Brudey M.D., Alipio Mascarenhas M.D., Dan Steinfink M.D., Nancy Donachie M.D, Vernon Charles Johnson, M.D., David Crumpacker M.D., Sara Jaquay MSN, PMHNP, Laura Slaughter M.D., Roland Tsopze Nurse Practitioner, Vernon Charles Johnson, M.D., Charukesi Chandrasekaran M.D.

Primary Care New Patient Forms

Please download the required form(s), print and complete. Bring completed form(s) to your appointment.

Pediatric Primary Care New Patient Form

Saira Dar M.D., Chevelle Brudey M.D.

Adult Primary Care New Patient Form

Saira Dar M.D., Chevelle Brudey M.D.