Request a New Patient Appointment
Name of person requesting the appointment
Name of person for whom the appointment is being requested, if not yourself
Date of birth of the person for whom you are requesting the appointment
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Email address at which you can be contacted
Telephone number at which you can be contacted
Please enter a valid phone number.
Reason for appointment request
Neuropsychological assessment (requires a referral from your healthcare provider)
Please provide additional information
Please note, some insurance companies contract with other insurance carriers to manage their behavioral health plans. Therefore, Dr. Emick may be a provider on your medical plan for the purposes of neuropsychological assessment, but not a provider on your behavioral plan for the purposes of psychotherapy. Providing your insurance plan and identification number will allow us to determine whether she is a provider on your appropriate insurance plan before an appointment is scheduled.
Your insurance plan and plan identification number.
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