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Initial Screening
Request For A Complimentary Initial Screening Appointment
Zoya Clinic is a fee for service tele-health practice and is
NOT
in contract with any insurance companies at this moment.
Dr. Hadizadeh is licensed in Minnesota and only provides care via tele-health to patients residing in
Minnesota
.
This request is not regarding a medical or mental health emergency.
Completing this form does not establish doctor-patient relationship.
YES, i understand
Full Name *
Date of birth *
Email Address *
Phone number *
HOW DID YOU HEAR ABOUT US?
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A current patient
Google Ad
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My therapist
Psychology Today
WebMD
None
What services are you seeking to begin or continue care for? *
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Medication management
Hormone therapy
Psychotherapy
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