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 the intake process. If the patient is over 18 years, they must complete this form themselves.
Please know that our outpatient clinic in San Jose and Oakland is not able to accommodate any additional patients at this time and, due to overwhelming demand, we are not maintaining a waiting list any longer. Menlo Park does have outpatient appointments available. Please note our Intensive Outpatient Programs (IOP) for San Jose, Oakland and Menlo Park are accepting new patients. If we are able to provide you a free needs assessment and referral to routine outpatient services is recommended, we will need to refer you to other clinics/clinicians 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.