Appointment Request Form
Acacia is an outpatient mental health clinic. We provide weekly individual therapy, couples therapy, group therapy, and medication management services to adults 18 years and older to address a variety of mental health needs. Acacia does not specialize in the treatment of chronic substance abuse and addiction or active psychosis. We do not accept minors (Children and adolescents 17 years and younger).

If you are an immediate danger to yourself or someone else or are otherwise experiencing a mental health emergency, please call 911 or go to the nearest emergency room.

**Acacia Santa Cruz currently has a waitlist and therefore is unable to guarantee an initial appointment right away. It is hard to estimate the wait, however it may be several months.**

PLEASE NOTE: This form is encrypted to ensure the privacy of your information.
Any and all information disclosed on this form is confidential and will not be sold or distributed to any third parties with the exception of Insurance billing purposes.

Thank you! Our staff will be with you within 24-48 hours.
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