T and C Psychiatric Services: New Patient
Thank you so much for your interest in T and C Psychiatric Services. We are accepting new patients!

These brief questions listed below help us to determine whether telehealth is an appropriate treatment option for you, as well as which of our providers would be the best fit for you.
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Email *
Please Include: Full name (first and last). *
Have you ever used a telehealth platform before? If so, which platform?  *
Patient Date of Birth *
What is your preferred phone number? *
We do not currently offer therapy services. At this time, we are only able to provide medication management and/or diagnostic services. *
What state do you currently reside in? *
What insurance plan do you intend to use (or self-pay)? *
Is your insurance a Medicare or Medicaid plan? *
Do you have a history of being diagnosed with a psychotic disorder (such as schizophrenia)? Note if you are unsure. *
Do you have a history of suicide attempts? *
When was your most recent suicide attempt? (If applicable) *
Do you have a history of psychiatric inpatient or residential treatment stays? *
When were you discharged from your most recent residential treatment or inpatient stay? (If applicable) *
Do you currently have intent to end your own life? *
If YES, please seek immediate assistance by calling 911, texting 741741, or calling the National Suicide Hotline at 1-800-273-8255 *
Are you seeking an evaluation for a specific form, work/academic accommodation, or surgery? *
What are you seeking evaluation for? (If applicable) *
Are you seeking a prescription for a stimulant or benzodiazepine medication? *
If you currently take a stimulant or benzodiazepine, please specify the medication and dose. *
How did you hear about us? (Referral, search engine, social media, etc.) *
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