• Adult Intake

    Please note: Progress on this form cannot be saved. It should take 10-15 minutes to complete. Continue to the end and click "submit."
  •  - -
    Pick a Date
  •  - -
    Pick a Date
  •  -
  • INSURANCE INFORMATION

    We are in-network with BCBS PPO and Macomb County Community Mental Health. We are also a certified non-network provider for Tricare. 

    As a curtesy, we will submit billing to out-of-network PPO plans but payment is due at the time of service. 

    We cannot bill to HMO plans or Medicaid plans. Please contact the office for cash prices. 

  • Browse Files
    Cancelof
  • Please complete this form to the best of your ability so we can determine the proper evalautions to administer. We will be in contact within one business day to schedule an evaluation. 

  • Should be Empty: