Welcome to the Ghaly Healing & Wellness Center! If we've already contacted you to schedule an appointment, you will need to fill out our new patient packet. Please download and print the "New Patient Packet" below. Make sure to fill it out COMPLETELY, and bring to your appointment along with your insurance cards and photo ID. If you do not have this paperwork filled out prior to your schedule appointment time, you may be rescheduled due to time constraints.
***Please note, this form is for patients who already have their initial evaluation scheduled in our office and is not intended as a new patient referral form.
If you would like to be referred to our office please see the section below.
New Patient Packet (pdf)
DownloadOur office accepts new patients by referral only. If you are interested in becoming a new patient please contact your current provider (therapist, primary care provider, etc) and request they fax the following information to (315) 471-6760:
***TMS referral patients, make sure your referring provider indicates TMS on the paperwork***
- Demographics and Insurance Information
- Reason for Referral
- Current Progress Notes
-Medication List
Once all of the necessary information is received, it will be reviewed by one of our providers to determine if the referral will be accepted. If accepted, our office will contact you directly to schedule your new patient evaluation. If you have any other questions please feel free to call our office.
Please note, we are a medication management office and do not provide talk therapy or counseling. For a list of local councilors please click the link below:
Therapy Referrals (pdf)
Download