Practice Transition Consent - SanityTeam Logo
  • Psychiatry Follow Up Outpatient Visit & Mental Status Examination

    Practice Transition Consent and Acknowledgment

    12 SE 7th Street, Suite 705, Fort Lauderdale, FL 33301
  • As part of an organizational realignment, some of Crasmere Psychiatric Services, PC will be formally transitioned to The Private Mental Health Group, LLC effective 05/01/2025. 

    Key Details About This Change: 

    - Your care team remains unchanged – You will continue seeing the same provider(s) without interruption. 

    - Treatment plans stay the same – All current medications, therapies, and appointments will proceed as scheduled. 

    - Billing updates – The primary change will be the billing entity name (from Crasmere Psychiatric Services, PC to The Private Mental Health Group, LLC). You will receive separate notification if this affects insurance/payment processes. 

    - Privacy protections unchanged – Your medical records remain strictly confidential under HIPAA and will seamlessly transfer to the new practice. 

    Your Consent: 

    By signing below, you acknowledge this administrative transition and confirm your understanding that your care team, treatment, and privacy protections will continue without alteration. 

     

    Patient Acknowledgement: 

    I understand my care is transitioning from Crasmere Psychiatric Services, PC to The Private Mental Health Group, LLC as of 05/01/2025. I confirm that: 

    - My current provider(s) will continue overseeing my treatment. 

    - I consent to the transfer of my medical records to the new practice entity. 

    - I’ve been informed that billing will now reflect The Private Mental Health Group, LLC.

    - I’ve had the opportunity to ask questions about this change.

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