After Hours Agreement Notice To Patients:

You may contact your provider via phone at Petal Psychiatry, Monday-Friday 9am-5pm, regarding any psychiatric concerns/ medication concerns.

If you require urgent and/or emergent psychiatric assistance, we encourage you to please call 911 and/or 211 or proceed to the nearest emergency department.

Petal Psychiatry does have an after-hours phone service, but this service is limited in capabilities given the after hours nature. We also do not provide refills/ emergent medication requests after hours.

Patient Name:* Electronic Signature:* Date* Email Address*

You agree your electronic signature is the legal equivalent of your manual signature on this agreement.

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