Get Started

In case of a medical emergency, psychiatric crisis, or if you are at risk of harming yourself or others, CALL 911 or seek the nearest emergency room. DO NOT use this form.

To Schedule Your Intake Appointment Use Our Online Scheduler

Online Scheduling

Once scheduled, you will receive a confirmation email with consent forms, please complete before your intake appointment. Prior to your appointment you will receive an email from [email protected] with a zoom link and instructions on how to attend your intake appointment.

To Submit A Referral

Download the PDFs above or fill out and submit online through the forms below:

• Patient Referral Form

  • Appointment Requested*
    TherapyMedication ManagementGroup Therapy
  • Patient Name*
  • DOB*
    
    Month

    
    Day

    
    Year

  • Phone*
  • Email*
  • Address
  • Insurance Carrier*
  • Insurance Subscriber ID#*
  • Special Instructions

  
  
  

  
  
  
  
  

• Agency Referral Form
  • Referring Department*
    • 
      Intake
    • 
      Inpatient
    • 
      Outpatient
  • Confirmed Telemedicine Capabilities
    • 
      Yes
    • 
      No
  • Appointment Requested*
    TherapyMedication ManagementGroup Therapy

  • Complete the following if patient has a prescription for controlled substances and/or long acting injectables.

  • Controlled Substances (PCP contact information)

  • Name
  • Phone

  • Long Acting Injectable Rx (Pharmacy information)

  • Name
  • Phone

  • Patient Information

  • Patient Name*
  • DOB*
    
    Month

    
    Day

    
    Year

  • Phone*
  • Email*
  • Address
  • Insurance Carrier*
  • Insurance Subscriber ID#*
  • Anticipated Discharge Date*
    
    Month

    
    Day

    
    Year

  • Referring Clinician*
  • Referring Clinician Phone & Email Address*
  • Special Instructions

  
  
  

  
  
  
  
  

Once the referral is received our care navigator will give you a call to get started.

Athena Portal

We’re using athenahealth to help you access your health information and manage your treatment. Click below to get access to the portal.

Visit Patient Portal