Gateway Psychiatric Group, LLC- New Patient Inquiry
Thank you for reaching out to us about scheduling a new patient appointment. We hope we can be of help. Due to the nature of the field of psychiatry, we have a few requirements before we schedule.

**CURRENTLY ALL OF OUR MEDICAID SLOTS ARE FULL, PLEASE CHECK BACK IN 6 MONTHS TO SEE IF THERE IS ANY AVAILABILITY**

In-Network Insurances: Anthem, Blue Cross Blue Shield, Aetna, Cigna, United Healthcare, UMR, Traditional Medicare, Mercy, Tricare. If you are unsure if your insurance falls under one of these networks we would be happy to check for you. If you do not see your insurance company listed we do offer Private Pay appointments as well.
Email address *
First Name of Patient (How listed with Insurance) *
Last Name *
Preferred Name (optional)
Address (PLEASE INCLUDE ZIP CODE) *
Date of Birth of Patient *
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DD
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Phone Number *
Primary Insurance Company (if self pay put none) *
Primary Insurance Member ID # (if self pay put none)** MAKE SURE THIS IS NOT THE GROUP NUMBER** *
Secondary Insurance Company (if any)
Secondary Insurance Member ID # (if any)
Reason for Appointment (brief, no need for specific details) *
Because of the high rate of late cancellations and no shows for new patient appointments, we require a $50 deposit at the time of scheduling. We will not be able to schedule until this deposit can be made. The $50 will go into your account as a credit and will be put towards any balance due. If you decide to cancel, as long as we receive cancellation notice 24 hours prior to your appointment your deposit can be refunded. This is to help keep wait times at the lowest minimum possible. We would be happy to answer any additional questions about this policy when we call to set up your appointment. *
Required
For the time being all appointments will be done via telemedicine. In order to comply with HIPAA compliance we will require you to downlaod a specific App that meets the requirement. If you have a device that has a camera and microphone a telemedicine appointment is easily done. CHOOSE ONE *
Required
Due to an extremely high volume of calls for new patient appointments it may take 4-5 business days before someone contacts you. If you still have not received a call or an email for additional information after 5 business days please give us a call to check the status. *
Required
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