Appointment Request Form
To request a new appointment, please fill out the form completely and a member of our administrative team will contact you regarding next steps. If the potential patient is over 18 years of age, they must complete this form themselves.
Please know that our sites sometimes close intakes into certain services/programs due to overwhelming demand. We strive to keep this website updated so potential patients know what our availability is. If we are able to provide you a free needs assessment and referral to a service we offer is appropriate (but we are not able to accommodate), we will need to refer you to other clinicians/programs in the community. We are actively recruiting psychiatrists and therapists at all three of our clinic sites in order to grow to meet the community's needs.
Before completing this form, please review our FAQ regarding our Free Needs Assessment.