TimMurphyMD
577 E. Elder St., Ste. C
Fallbrook, CA    92028
phone (760)723-5459
fax:  (760)723-7872
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Registration Forms, Privacy Policies and Release of Information Permissions

You are encouraged to complete the registration form and bring to your first visit, or you may send them to us by fax or email.  (fax: (760) 723-7872;  email: fallbrookpsychiatry@gmail.com)

COVID-19:  During the corona virus pandemic, Dr. Murphy encourages patients to have their appointments by telehealth.  This may be done on a mobile phone, or on a computer that has a camera.  Make sure your camera and microphone are enabled and paste the following link onto your browser:   https://doxy.me/timmurphymd  (or click on this LINK now)
1. New Patient Registration Form (required for new patients)
File Size: 46 kb
File Type: pdf
Download File

2. Registration Form for Dependent (required for dependent patients)
File Size: 55 kb
File Type: pdf
Download File

3. Secondary Insurance
File Size: 30 kb
File Type: pdf
Download File

4. Consent for Verbal Communications (required)
File Size: 505 kb
File Type: pdf
Download File

5. Receipt of Privacy Practices (required)
File Size: 170 kb
File Type: pdf
Download File

6. Office Privacy Practices (information only)
File Size: 122 kb
File Type: pdf
Download File

7. Release of Medical Information
File Size: 102 kb
File Type: pdf
Download File

8. Credit Card Authorization Form
File Size: 149 kb
File Type: pdf
Download File

9. Medicare Private Contract (required for patients with Medicare)
File Size: 186 kb
File Type: pdf
Download File