REQUEST A NEW PATIENT APPOINTMENT

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Important Intake Information: All fields on this form are required. If you are experiencing a mental health crisis or emergency, please call 911 immediately. Upon submission of the Intake Form, the next step is Insurance Verification. Once insurance has been verified, your intake will be reviewed by our nursing staff. Following this review, a member of our team will contact you to schedule an appointment. Please allow approximately 7 to 14 days for this process. For individuals without insurance, the initial visit is $200. A non-refundable deposit of $100 is required to schedule the appointment and will be applied toward the first visit. All follow-up appointments are $120 and must be paid in full at the time of service.