Thank you for your interest in becoming a new patient!
Complete Forms
Using the forms below
Treatment Plan
45-60 minute visit evaluation
“Our Practice Relies On Fully Current, Cutting-Edge, Evidence-Based Medicine.”
Dr. Burstein and P.A. Michael Sandridge have 40+ years of combined experience treating patients 11 and older. They rely on fully current, cutting edge, evidence based medicine to treat patients with a variety of mental health needs, including those with complex problems who have not yet responded to treatment elsewhere.
Due to limited availability, we are only able to accept new patients on a limited basis. Please visit our FAQ for information about our office, including accepted insurance plans. To request a new patient appointment, please fill out the form in the button below. One of our staff will reach out to you to complete the remaining intake process.
Thank you for your interest in becoming a new patient!
Â
Dr. Burstein and P.A. Michael Sandridge have 40+ years of combined experience treating patients 11 and older. They rely on fully current, cutting edge, evidence based medicine to treat patients with a variety of mental health needs, including those with complex problems who have not yet responded to treatment elsewhere.Â
Due to limited availability, we are only able to accept new patients on a limited basis. Please visit our FAQ for information about our office, including accepted insurance plans. To request a new patient appointment, please fill out the form in the button below. One of our staff will reach out to you to complete the remaining intake process.
Complete Forms
“Book Appointment” & “New Patient” forms (below)
Initial Assessment
Have 45-60 minute discussion with the doctor to discuss your history ​
Treatment Plan
Your plan to get healthy that’s a mix of therapy and/or medication
We accept many types of insurance
Please review our FAQs for more details on the specific plans we do and don’t accept
New Patient Forms (Complete after hearing back from office)
Practice Policies
4 pages. Consents, Payment Method and Policy.
Clinical History
8 pages. Clinical History, Question & Answers.
Release of Info
1 page. Authorization to share records.
Annual Update
3 pages. Update contact info, insurance, etc.
Once your first appointment has been confirmed, you will need to complete the New Patient paperwork (“Practice Policies” and “Clinical History”) above. Please upload a copy of your Driver’s License and Insurance card(s) [below] or email to frontdesk@wellbeingsys.com.
If you prefer to fill out the paperwork by hand instead, please print and complete our New Patient Registration Forms. You may then scan and email them to frontdesk@wellbeingsys.com OR mail them to our office.
All paperwork must be received no less than 7 days before your appointment.   If you have pertinent medical records, please complete the Release of Information form and provide to your other healthcare provider. Please ask your provider to send a copy of your records prior to your appointment.Â
New patients – Please upload a copy of your Driver’s License and Insurance card(s).
This can also be used to share any other forms or documents with us.Â