IF YOU ARE IN CRISIS and need immediate emergency attention, PLEASE CALL 911 or go to your local hospital emergency room. This intake form will not direct you to a crisis line or crisis services. It may be several hours or the next day before we can respond, verify benefits, and schedule an appointment.
In order to schedule and hold an appointment, we require a credit card. Please provide credit card information only when requested by phone.
(After we enter the card information, according to federal law, the actual number cannot be seen))
We DO accept the following insurance companies:
Medicare, Blue Cross Blue Shield, Aetna, CIGNA, United Healthcare/OPTUM.
We DO NOT accept the following insurance companies:
Medicaid, Beacon, Freedom, Value Options, Magellan, Great West, Mental Health Network