223 MILLER RD, AVON LAKE, OH 44012, USA

Phone: 440-930-2002 Fax: 440-930-2085

Phone: 440-930-2002 Fax: 440-930-2085

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New Patient Intake

If you would like to become a patient with Dr Almhana or Dr. Haidar, please fill out the Intake below and send to Hanpsychllc@gmail.com and the office staff will get back to you after the doctors approval.

NEW PATIENT INTAKE (pdf)

Download

Patient Forms

These forms are for New Patients. Please download, fill out and bring to your first scheduled appointment.  Please bring your Insurance card and Photo ID as well. Also please arrive at least 10 minutes before your appointment. 

Patient Registration Update 2024 (pdf)

Download

Mood Questionnaire (pdf)

Download

NICHQ Parent Forms (pdf)

Download

NICHQ School Forms (pdf)

Download

Release of information 2024 (pdf)

Download

Reviews

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