TARAL SHARMA, MD, PC

120 PELHAM LN

Phone: (864) 844 – 9432

Fax: (864) 844-9430

Practice Communication & Patient-Provider Relationship

When our office books your appointment, we are setting aside a dedicated time slot just for you. We only ask that if you must reschedule your appointment, that you please provide us with at least 24 hours notice. This courtesy makes it possible to give your reserved time slot to another patient who would be more than happy to accept.

I undersigned

with the Date of Birth allow Taral Sharma, MD, PC and all its employees to contact me on the following phone numbers and leave voice messages and text messages. I also allow Taral Sharma, MD, PC and all its employees to communicate me via email at the following email addresses: Phone Number(s): ,
(Initial) Allow Calls, Texts and/or Voicemails (circle each one that is applicable)
Email address(s): ,
(Initial) Allow email communications

Patient-provider relationship agreement:

Your relationship with your doctor is at your discretion. You have the right to seek mental health treatment from any provider with whom you feel comfortable. If you have concerns about the quality or nature of the services provided, concerns about our staff, building, or billing procedures, please let your doctor know. Discussing these issues will strengthen our working relationship and in no way harm the quality of services you will receive at our clinic..

We reserve the right to terminate medication management/therapy services if anyone behaves inappropriately towards a doctor or office staff, if there is consistent failure to attend scheduled appointments, if there is failure to complete payment for services, or if either patient/parent does not consent for services for a child. Your signature below indicates that you have read the information in this document and agree to abide by its terms during our professional relationship.

Patient’s Name:
Patient Signature:
Dated: