This form helps prospective patients and clinicians connect more efficiently and explore whether the requested relationship will be a good fit. Submitting this form, any other intake forms and rating scales does not constitute the formation of a treatment relationship. We review these forms to determine if our practice is a good fit.
If you are or believe you are experiencing a medical or psychiatric emergency, including suicidal or homicidal thinking, side effects to medication, or any other urgent or time-sensitive matter in which you need an immediate response, do not use this service. Instead call 911 or go to your closest emergency room.