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Ramineni Rao, MD 

Mental Health Services for Adults and Children

Certain forms must be filled out prior to your first appointment with the provider. Just click on the link below to access and print the necessary forms.

**Click Here to Read Instructions for Completing Forms**

English Documents

Adult/Parent Appointment Child Appointment
Adult Personal Data Sheet Adolescent Questionnaire (12 Years Old or Older Completes)
Child, Adolescent, and Family Data Sheet (Parent Completes)

Documentos en Espanol

Cita del Adulto/Padres Cita del Nino/Nina
Hoja de datos personal del adulto Cuestionario del Adolscente (de 12 aņos de edad o mayor completa)
Hoja de datos del nino/nina, adolescente, y la familia

 


Disclaimer
If you think you have a MEDICAL OR PSYCHIATRIC EMERGENCY, CALL 911 IMMEDIATELY or go to the nearest hospital. DO NOT attempt to access emergency care through this web site. An emergency medical condition is a medical or psychiatric condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in any of the following: serious jeopardy to your health, serious impairment to your bodily functions, or serious dysfunction of any bodily organ or part. An emergency medical condition is also "active labor," which means a labor when there is inadequate time for safe transfer to a Plan hospital (or designated hospital) before delivery or if a transfer poses a threat to the health of the member or unborn child.

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