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Appointment Request
For patients under 18
Reason for Visit
(Briefly describe what you are seeking help for)
Short Description
Current Treatment
Insurance Information
Availability
Important Information (Please Read)
Please allow up to 24 hours for intake processing after submission.
If your insurance is in-network, you will receive intake forms via our secure portal (SimplePractice).
All intake forms must be completed within 24 hours to proceed with scheduling.
Appointments are not confirmed until intake forms are completed and insurance is verified.
Once completed, you may request your appointment directly through the patient portal.
I consent to be contacted by Precision Mental Health and Consulting Services regarding scheduling, verification, and care coordination*
