GeroPsych Maine LLC Contact Form

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Use this form to make initial contact with Dr. Tom Meuser and GeroPsych Maine LLC (https://geropsychmaine.com/).

The information you provide here will help guide an initial phone conversation about your interest in and.or need(s) for services from this practice.

*** By completing this form, you agree that the entered information is to support an initial discussion about potential future services only. Completing this form does not make you or any person or entity you are inquiring about a client of GeroPsych Maine LLC. There is a separate onboarding process to become a formal client. For clinical clients, this onboarding process occurs through a secure "digital health record" system to which prospective clients are directed if services appear warranted.

Which of the statements below best describes your outreach today to GeroPsych Maine LLC?

What concern(s) motivate your enquiring about services from GeroPsych Maine LLC? Check all that apply.

Brain/Cognitive Health (e.g., change in memory and thinking)

Emotional Health (e.g., withdrawal from others, low mood, excessive worry, depression)

Functional Health (e.g., change in ability to complete important life tasks correctly/safely)

Psychiatric Health (e.g., change in core beliefs, paranoid thoughts, seeing/hearing things)

Physical/Medical Health (e.g., struggling to manage acute and/or chronic conditions)

Level of Care Concern (e.g., current in-home or in-facility supports not working)

Legal Competence/Capacity Concern (e.g., change in ability to make reasoned decisions)

Exploitation/Abuse Concern (e.g., financial exploitation, unexplained injuries, undue influence)

Need Associated with an Organization or Professional Practice

My concern is not represented in the choices above. I will explain when we speak.

Required

Urgency of your need? Choose one. *

Your Full Name *

Your Email Address (for scheduling) *

Your Cell/Daytime Phone Number (including area code) *

In what State do you reside or do primary business? *

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