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12359 Sunrise Valley Drive, Suite 320, Reston, VA 20191
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My Psychiatrist
Schedule New
Patient Portal
New Patient
(571) 946-2189
Existing Patients
(703) 596-4796
  • Home
  • Services
    • Medication Management
    • Counseling
    • TMS
    • Panic Disorder
    • ADHD
    • Anxiety
    • Depression
    • Bipolar Disorder
    • Psychotic Disorder
  • Clinicians
    • Madan Uprety, MD
    • Sanju Adhikari, MD
    • Ryan Vesny, MD
    • Samina Raja, MD
    • Meira Yasin, PMHNP-BC
    • Mukta Gautam, PMHNP-BC
    • John Getz, Psy.D
    • Kathleen Martens, Psy.D
    • Jeff Martens, Ph.D
    • Kara Callaghan, LPC
    • Rosanna Farrell, LCSW
  • Clinic Policy
    • Medication Refill Policy
    • Cancellation Policy
    • Financial Policy
    • Notice of Privacy Practices
    • Insurance
  • Testimonials
  • Forms
    • Patient Portal & Forms
      • Patient Intake Form
      • Consent to Release Form
    • Patient Resources
  • COVID-19 Response
  • Contact

Professional, concerned
& compationate psychiatric care.

Patient

Intake Form

ONLINE FORM
GET FORMS

Download and complete our Patient Intake Forms.  You can bring them to your first appointment or email them to us.
Click HERE to email your forms.

New patient
Existing Patient

Learn More

  • Consent to Release Form

My Psychiatrist, PLC

12359 Sunrise Valley Drive, Suite 320, Reston, VA 20191
New Patient Hotline: (571) 946-2189
Existing Patients:(703) 596-4796
Fax: (703) 787-8210

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