Existing Patients
When necessary, our providers will request that you complete one (or more) of the following forms and email it to support@adi.health.
ADI Patient Guide, Acknowledgement of Practice Policies, and Consent for Treatment
All existing patients will be required to accept the OnPatient invitation and are asked to review these policies at every visit.
In Case of Emergency
As outlined in this guide, if you are experiencing an emergency and/or life-threatening situation, please call 911. If you are hospitalized or require urgent assistance / care during non-business hours, Dr. Sharma can be reached via her answering service at 800-330-1275. All non-urgent calls will be billed a minimum of $25.
Credit Card on File (Required for All Patients New & Old)
To be filled out by all patients new & old. PLEASE DOWNLOAD, complete, save as PDF, and upload/send as an OnPatient Message with the subject line “Credit Card on File Agreement.”
If you are having issues sending this via Messages, please send it to support@adi.health with the subject line “Credit Card on File Agreement.”
Release of Information (“ROI”), aka Authorization for Use or Disclosure of Information for Patient Care
Under the Health Insurance Portability and Accountability Act (HIPAA), this form must be completed to disclose specified health information and release information for patient care purposes to the authorized user.
Medication Consent (Required For All New Medications/Prescriptions)
This form is to be filled out upon the request of the doctor. Patients must email the form back via OnPatient Messages (or if necessary, to support@adi.health) in a timely fashion. Delays in returning a signed copy of the form will result in a delay of your prescription.
Parent Questionnaire (Required For New Patients Under the Age of 18)
To be filled out by all parents of patients under the age of 18, or as requested for the purpose of evaluation.
New Patients
Step 1: Complete the New Patient Request Form
Step 2: Schedule Your New Patient Appointment(s)
Once we review and approve your information, someone from our office will call to schedule your appointment. If you don’t receive a call in 3-5 business days, please call 847-577-7705.
You will be scheduled for two appointments (60m for the initial evaluation and 30-40m in 1-2 weeks for the follow up visit for all psychiatry and medication management visits). Once these appointments are made, you will receive links for your telemedicine visits (if applicable)
Step 3: Accept OnPatient Invite & Use Browser to Create Account (App Does Not Work)
You will also receive a time-sensitive invitation to register to OnPatient. You will have a limited time-frame to register (48 HOURS), so please open the email from “onpatient Invite” immediately and follow the directions outlined in The OnPatient Registration Process Guide to create your account and connect to Dr. Sharma.
Step 4: “Check-in” via OnPatient
Once you are logged in to OnPatient, go to the Appointments tab and follow the directions in the Registration Patient Check-in & Onboarding Guide to complete your profile, upload images of your insurance card (front and back of your card), submit your medical history (under reason for visit select new patient form), and review & sign off all policies and consent forms.
**If we do not receive these documents within 48 hours of your appointment being scheduled, your appointment may be cancelled and released to another patient on our waitlist.
Step 5: Submit Remaining New Patient Forms via OnPatient Messages
Submit the below forms (ALL REQUIRED) via OnPatient Messages (PDF, JPEG, PNG only; 1 attachment per message only), fax, or email:
An Authorization for Use or Disclosure of Information for Patient Care (ROI) should be completed for any/all parties that you would like to authorize our team to connect with regarding your care. This could include a family member, therapist, or provider from whom we should connect with regarding your medical records (REQUIRED FOR ALL PATIENTS WHO CURRENTLY HAVE A PSYCHIATRIST OR THERAPIST, AND FOR ALL PATIENTS OVER THE AGE OF 18 WHO WOULD LIKE THEIR PARENTS/ANOTHER PARTY TO BE INVOLVED IN THEIR CARE)
Parent Questionnaire (REQUIRED ONLY FOR PATIENTS UNDER THE AGE OF 19)
Insurance Card (front & back)
Drivers License (front & back - for the patient OR responsible party)Any additional information you’d like to share with the provider
**If we do not receive these documents within 48 hours of your appointment being scheduled, your appointment may be cancelled and released to another patient on our waitlist.
_________________________________________________________