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Please fill out this FORM to Request an Appointment!
Click here & Request an Appointment Online!
 Patient Forms 

We have designed this self-registration page four our patients to complete all required paperwork before your first visit!


The patient registration packets (standard & suboxone packets) consisting of the information listed here, a form requesting information from your insurance company and permission for us to bill for your services and finally a credit card authorization form permitting us to debit your card 50 dollars to recevie your appointment. This 50 dollars will be applied towards a credit in your first visit co insurance pay.
 

Follow these simple steps in order to complete your request for an appointment along with your patient registration forms.


STEP 1: Request an Appointment!


*STEP 2: Patient Registration Packet


*IF YOU ARE REQUESTING AN APPOINTMENT FOR PAIN KILLER TREATMENT (SUBOXONE) PLEASE USE THIS LINK: Suboxone Patient Registration Packet
 
 
STEP 3:  PATIENT PORTAL: Sign In Now To Ask a Question, Schedule an Appointment, or Access Your Medical Information. The patient portal is mandatory and requires you to have an email.
 
 
Once you have completed your Appointment request followed by your patient pre-registration packet, our Intake Coordinator will contact you to confirm your appointment.
 
ADDITIONAL PATIENT FORMS:



COMPLETE THIS FORM TO OBTAIN A COPY OF YOUR MEDICAL RECORDS and is required with any kind of communication that will disclose any aspect of your pschiatric history: Request of Release of Medical Records
 

COMPLETE THIS FORM IF YOU WISH FOR A PERSON TO PARTICIPATE DURING YOUR VISIT: Form to complete for friends and family to participate in treatment



THIS FORM IS REQUIRED FOR ALL PATIENTS:  Credit Card Charge and Check Authorization

1. If you were unable to complete the retainer fee via PayPal
2. In the event of missed initial, follow up or cancelled appointments not rescheduled 24 hours in advance

Dr. Lado is a Fellow of the American Board of Forensic Examiners and Board of Forensic Medicine (ABFE), the world's largest forensic science association.  I can conduct forensic research and examinations as a physician in the field of psychiatry and have provided testimony as a professional.  Please be aware, if you are court ordered or attorney referred for treatment or evaluation, that your medical records may not be protected by HIPAA laws and may be public records and you waive your privacy rights. You must fill out the consent form so we can discuss your case with your attorney. COURT ORDERED evaluations and disability evaluations are NOT COVERED by insurance companies and you will need to pay at time of service. A retainer will be required with all ATTORNEY related cases. Informed Consent for Forensic Assessment
 

 
Advance Beneficiary Notice of Non-Coverage (ABN) is a written notice given to a Medicare and/or Commercial Insurance beneficiary by a physician when he or she believes that Medicare will deny some or all of the services or items because of medical necessity or the frequency of the service. Advanced Beneficiary Notice of Noncoverage (ABN)

 
Pursuant to statute 409.912(51) The Agency may not pay for a psychotropic medication prescribed for a child in the Medicaid program without the express and informed consent of the child’s parent or legal guardian. The physician shall document the consent in the child’s medical record and provide the pharmacy with a signed attestation of this documentation with the prescription.
 
Florida Statute 394.492(3) “Child” means a person from birth until the person’s 13th birthday. Psychotropic (Psychotherapeutic) Medications include antipsychotics, antidepressants, antianxiety medications, and mood stabilizers. Anticonvulsants and ADHD medications (stimulants and non-stimulants) are not included at this time.
 
 
 
Psychiatry | Addiction Recovery | Suboxone and Campral treatments in Naples, Bonita Springs & South Florida

Lado Healing Institute ®
Leonard A Lado MDTM, RPh, ABPN

American Board of Psychiatry and Neurology
Board Certified Psychiatrist

9776 Bonita Beach Rd Suite #202B
Bonita Springs, FL 34135
Phone: (239) 948-4325
Fax:    (239) 288-0574
Email: email@ladomd.com

>>> Located inside the HealthCare of Bonita Springs Building!


© 2007 -2017 copyright Leonard A Lado MDTM
® http://www.ladomd.com/

9776 Bonita Beach Road SE, Suite 202B

Bonita Springs, FL 34135
>>> Located inside the HealthCare of Bonita Springs Building!
 

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