FROM THE CARENCIA TEAM
THANK YOU FOR YOUR COURAGE
We know that reaching out for help regarding your mental health is not easy. We hope you are proud of yourself for taking this step, and we're honored to be considered for your treatment.
In order for our team to serve you as efficiently and effectively as possible, we ask that you fill out this questionnaire so that we can ensure we have all needed information and we are the proper fit to serve your mental healthcare needs. All of our forms are secure and HIPAA compliant, so you can provide all requested information without concern.
*Please Note* If having difficulty submitting the form, please use the steps below to troubleshoot the issues. While the form can be completed on a mobile device we do recommend using a computer with Google Chrome or Microsoft Edge or Safari (if using a MacOS device).
- Clear all browser cache/cookies/history
- Try private or incognito mode in the browser
- Try a different browser or computer or mobile phone
If you are having trouble with the form or have questions regarding the form, please contact us at email@example.com.