Virtual Care

Telehealth Portal

Telehealth Check in

Full Name

Email Address

Phone Number

*Agree with SMS Opt in policy

By providing your phone number and checking this box, you agree to receive SMS appointment reminders and care notifications from Psychvisit. Message frequency may vary. Standard Message & Data Rates may apply. Reply STOP to opt out. Reply HELP for help. Providing consent is not a condition of purchase. We will not share your mobile information with third parties for promotional or marketing purposes.Read More at Privacy Policy here :

https://www.mypsychvisit.com/privacy-policy

*Agree with SMS Opt in policy

https://www.mypsychvisit.com/privacy-policy

*Agree with SMS Opt in policy

https://www.mypsychvisit.com/privacy-policy

NEXTVISIT AI: I consent to audio recording of our clinical sessions using Nextvisit Ai software for the purpose of providing optimal care and documentation for your session. I understand that these recordings will not be stored for more than 30 days. (Not Shared with Anyone and for Clinical Purposes Only) *

CREDIT CARD: By checking off you authorize the Practice to Charge Credit on File if a fee is due: The payment policy of the practice allows them to use the payment method saved on file to cover any outstanding balances, including fees for late cancellations or no-shows, without requiring additional authorization. However, if you do not have a copay or wish to use a different card that is not saved on file, or if you do not have any payment method saved on file, the practice will contact you to arrange for payment if necessary. *

Pick Provider

TeleHealth Hours 9am-7pm Mon-Sat *Dr.Rafiq is Only Available 11am-4pm Mon-Thurs

Preference for Next Appointment

Your Provider Will See You Soon!

If You Have Trouble Please Call Front Desk and They will Help you!

MUST BE A NEW YORK STATE RESIDENT

(631) 440-1010

120 Broadway Amityville NY 11701