New Patient AppointmentsSimply fill out the form

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New Patient Signup Form

Patient Contact Info

You will be asked to provide insurance info on the following pages. Please note that we do not accept medicaid.

Please type your full name.
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Please specify your gender.
Referral Info
If you are not currently prescribed any medications, please write "None" in the appropriate field.
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Primary Insurance Information

We accept the following forms of insurance: BCBS, Cigna, ComPsych, Consumer's Choice, Coventry, Magellan, Medcost, Medicare, MHNet, Multiplan, Tricare/Tricare Prime, and United Behavioral Health/United Health Care. We do not accept Medicaid.

All fields must be filled out. Please write "NA" in each field if you do not have insurance.

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Secondary Insurance (if applicable)

We accept the following forms of insurance: BCBS, Cigna, ComPsych, Consumer's Choice, Coventry, Magellan, Medcost, Medicare, MHNet, Multiplan, Tricare/Tricare Prime, and United Behavioral Health/United Health Care. We do not accept Medicaid.

All fields must be filled out. Please write "NA" in each field if you do not have insurance.

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Please let us know how and when to contact you.

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New Patient Forms

Once you have completed the online form here, print and fill out these forms. Bring them with you to your appointment in order to speed up your wait time.

Click Here

Helpful Links

Check out these helpful links for more information on many types of mental health issues and prescription drugs.

Click Here

Questions?

If you have questions about our office or
whether we take your insurance,
give us a call at (843)735-6799.

Call Now