08:00 am - 05:00 pm
TeleVisit
Book Appointment Yourself
Book Appointment With office
Phone
Address
Email
TeleVisit
Home
McKinney Office
Frisco Office
Plano Texas
What We treat
PTSD
ADHD
Depression
Conduct Disorder
Tourette/Tics
Bipolar Disorder
Panic Attacks
OCD
Anxiety Disorder
Autism Spectrum
Social Anixety
Telepsychiatry
Skin Picking
Trichotillomania
TMS Therapy
Resistant Depression
Our Reach
Allen Texas
Prosper Texas
Carrollton Texas
Aubrey Texas
Mesquite Texas
Sherman Texas
Richardson Texas
Irving Texas
Patient Resources
Patient Forms
Dr. Sadaf Noor
McKinney
Adult Intake form
Child Intake form
Frisco Office
Adult Intake form
Child Intake form
Dr. Farah Ali
Frisco Office
Intake form
Rebecca Phipps
Frisco Office
Intake form
Jim Hughes
Frisco Office
Intake form
Dr Haqqani
Frisco Office
Intake form
Patient Guide
ADHD hand-out
Anxiety hand-out
Depression hand-out
Meet Our Providers
Sadaf Noor, MD
Caroline Sam
Marc Kitano
Social Skills Classes
Blog
Contact Us
X
Request An Appointment
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1
Step 1
First Name
Last Name
Email
email
Phone Number
What is the main reason for the visit?
Are you currently under the care of a Psychiatrist?
Have you ever been diagnosed with any Psychiatric Condition?
Are you currently taking any medication?
If yes, what is the name of the medication?
Do you have any insurance?
If yes name the carrier?
Do you have any preferred request for psychiatrists location-wise?
Sadaf Noor, MD
Caroline Sam, NP
Do you have have any preferred request for the therapist location-wise?
Marc Kitano
Do you have any history of the following condition?
Seizure Disorder
Yes
No
Wolff Parkinson White Syndrome
Yes
No
Stroke
Yes
No
Fibromyaigia
Yes
No
High Blood Pressure
Yes
No
Chronic Pain Issue
Yes
No
Heart Diseases Such As Arrhythmia
Yes
No
Neurological Disorders
Yes
No
Has there been a history of the following?
Do you have any current/past history of drug abuse?
If yes when?
Do you have any current/past history of alcohol abuse?
If yes when?
Do you have any current/past history of marijuana abuse?
If yes, when was the last time you used?
Do you have any pending legal issues?
If yes please explain
Will you be requiring a disability document to be filed?
Please answer, if the appointment is for a child
Yes
No
Are the parents of the child divorced?
Are there any custody issues?
Submit Form
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