@Ease Psychiatry

Intake Forms


The following providers are available for new patient appointments:

Nwamaka Emeruem, DNP, APRN, MBA, FNP, PMHNP
Ebere Ejike-Ilechukwu APRN, MSN, PMHNP-BC

Please follow all the steps to complete the new patient intake process:
STEP 1. Please select one of the options below (based on the patient’s age) for the set of forms you need
to fill out. You are required to answer all of the forms and all of the questions within the form. Please
make sure to wait for the “Thank you” response after submission to avoid any errors.

STEP 2. Please send a clear copy of the following IDs (front and back):
Insurance ID
Any valid ID

STEP 3. Call the office once done with Steps 1 and 2 to confirm receipt of forms and IDs. You will be
provided a schedule once all of the requirements have been successfully received.


• All new patients and re-established patients are required to complete the new patient intake
process. Steps are provided above.
• If you have difficulty with the steps for the new patient intake process, please call the office for
further assistance.
• If you are unable to answer the forms online, please call the office for more options.
• We are very strict with the intake process, if any forms or IDs are missing, you will need to
answer and/or send the forms and IDs again.
• If you have any questions or concerns, please call the office and an office staff will be happy to
assist you.

Thank you for your understanding and cooperation!

Should you encounter any difficulties with the forms, please let us know by calling the office. Our staff would be happy to assist you.