Interactive Appointment Request Form
New Patient Forms
To request a New Patient appointment online, use our interactive appointment request form above. We will respond to your request promptly. Before requesting an appointment:
- Review the doctor's fees, policies, and conditions treated on this website, specifically fees, details of insurance coverage, and what it means that the doctor is an out-of network provider.
- Use the appointment request form above and include your email address, name, and as much information as possible as to why you are seeking care with Dr. Zipperman, including a brief overview of past psychiatric treatment. Please also indicate first choice of appointment times.
- Dr. Zipperman or her staff will contact you to confirm appointment time and provide you further instructions.
- Before your first appointment, you will need to complete the following forms which can be completed online, alternatively you may print and fill out. Directions can also be printed below.:
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- Clinical History Form
- Clinic Policies New Patient Form
- Financial Guarantor Form.
- Directions to Fremont Office
- Pay $175 deposit through ONLINE BILL PAY.
- Financial Release Guarantor Form
- General Release of Information Form
What to Bring to Your First Appointment
- Completed forms (if not submitted online)
- Payment (cash, check, Health Savings Account Card, or major credit card)
- Any medical records that might be helpful in your evaluation
