Ann Arbor Psych Staff: Please give this document to the Ann Arbor Psych clinician noted below immediately
If you are an outside clinician or family member, please proceed below and thank you for opening up a line of communication. Collaborative care is the best care.
Collaboration of Care form
This form is for PCPs and Therapists to touch base on shared cases. For a response, please have patient fill out a HIPPA release on our website under "e-forms."
What is your relationship to the patient?
How would you like to be contacted (patient can fill out a release on our website)
Fax me at my secure fax
Email me at my secure email
I will call your office to arrange a time to speak (734 707 1052)
No response needed, just wanted to share observations
Phone Number (if that's how you want to be reached)
Fax number (if that's how you want to be reached)
Should be Empty: