Helpful Forms

Intake forms and patient forms

If you’re a new patient, please complete the following forms and bring them to your first session.

If you would like me to coordinate care with another provider (for example, primary care physician, etc.), complete this form to authorize release of your psychiatric information:

Call (334) 280-3230

Make an Appointment

New Patient Forms

New Patient Questionnaire

Click below to fill out the form if you're a new patient

Open Form

Consent For Treatment

Click below to fill out the consent for treatment form

Open Form

HIPAA Authorization Form

Click below to fill out the HIPPA Authorization form

Open Form

Release of Medical Records

Click below to fill out the release of medical records form

Open Form

Meet Our Doctors

Dr Clemmie Palmer, III, MD

Dr. Palmer is a psychiatrist who specializes in the psychiatric evaluation, complementary therapy approach, and medical management of an individual who is suffering from mental illness. This Psychiatrist provides services and maintains a private practice in Montgomery, AL.

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