I am an active patient at EKM Psychiatry with an established treatment history at this practice.*

I understand that submission does not guarantee documentation will be provided - eligibility is reviewed case by case.*

I understand a fee is due prior to work beginning and is non-refundable once documentation has been initiated.*

I understand EKM Psychiatry can only certify what is supported by my clinical record and cannot exaggerate symptoms or impairment.*

I have read and agree to EKM Psychiatry's documentation request policy.*