Request an Appointment

LADO HEALING INSTITUTE

Leonard A Lado MD·^TM, RPh, ABPN
American Board of Psychiatry and Neurology
Board Certified Psychiatrist

9410 Fountain Medical Court, Suite #200

Bonita Springs, FL 34135

Monday - Friday 9 AM - 5 PM

Phone: 239.948.4325

Click here for MAP or Driving Direction

If you need to cancel your appointment please fill out this form: Appointment Cancellations

Patient Information

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Patient First Name *

Patient Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Preferred Phone Number: (xxx)-xxx-xxxx

Area Code *

First 3 digit *

Last 4 digit * 🛈

Secondary Phone # 🛈

Email Address *

Patient Date of Birth * +

If you are not the patient Full name of the person who submits the form

The submitter relationship to the patient

Appointment Information

Appointment Type *

Reason for Visit *

We currently do not provide counseling but are able to do an evaluation and refer to a therapist.

We do prescribe medications.

Please note that a retainer fee may be required since legal cases require more documentation!

What you are needing treatment for? (Please check all apply) *

Are you visiting for pain killer (Suboxone) treatment? *

YES

NO

Please note that insurance companies will pay for the first evaluation but may not pay for induction!
(the first Suboxone treatment)

Is Suboxone already prescribed for you? *

YES

NO

Referred to Dr. Lado by *

Please specify *

Is this Patient under the age of 18? *

No

Yes

Lado Healing Institute only sees patients who are 18 or older!

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New Users / Returning Users CLICK HERE to setup or return to your account for this form. Creating an account enables you to return to this form and your submitted results. An account will also enable you to partially complete this form and return later to finish. The account you establish is only for this form.