Gila Ackerman, MD

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Psychiatrist

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Gila Ackerman, MD

FORMS

Consent to Obtain Medication History
(135K)
HIPAA Data Use Agreement
(175K)
Medical Records Request Form (Release of Information)
(240K)
Medicare Contract - Please complete if you have Medicare
(112K)
New Patient Form
(257K)
Patient Mood Chart
(54K)
Your Right as a Patient
(54K)