Online Scheduling

SCHEDULE YOUR APPOINTMENT
Name*

First NameLast Name
Date of Birth

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Appointment Request*

Mental Health/Medication EvaluationTherapy
Appointment Type*

VIDEOIN PERSON
INSURANCE/SELF-PAY*

YESNOSELF-PAY
Insurance Name/Type
Insurance Subscriber ID/ Medicaid Number
Appointment*
Disclaimer: Please be advised that scheduling an appointment does not guarantee service. All appointments are subject to eligibility verification and the submission of required documentation. Appointments will only be confirmed upon successful completion of these requirements. If you are experiencing a medical or mental health emergency, please call 911 or go to your nearest emergency room.
Should be Empty:

SCHEDULE YOUR APPOINTMENT