Application for pro-bono 15 minute consult
These slots are reserved for those unable to afford care to see if there is anything of use that Dr. Kumar can provide in a brief phone conversation to assist those needing direction in where to go and what to look for.
I understand that Dr. Kumar is only able to do a limited number of these consults. He may not be able to respond to this application.
Yes
No
Name
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First Name (Preferred Name)
Last Name
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email address
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Date of Birth
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What are you looking to have help with?
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Have you seen anyone in the past? What did they advise?
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Have you had suicidal or homicidal thoughts within the last year?
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Have you taken any prescriptions before, and if so, what were they and how did they affect you?
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Please be aware these slots are reserved for those unable to afford care to see if there is anything of use that Dr. Kumar can provide in a brief phone conversation. Please let us know if you fall into this category. If you feel comfortable you can provide more details on the financial difficulty but this is purely optional.
Do you acknowledge that you understand that a doctor patient relationship is not being formed with Dr. Kumar and that he cannot provide treatment or any official diagnosis in this brief encounter.
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Yes, I Acknowledge
No, I do Not Acknowledge
You agree to not hold Dr. Kumar or Ann Arbor Psychiatry liable for any aspect of this interaction as this falls under the "Good Samaritan" purview.
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I Agree
No, I do Not Agree
Submit
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