Request a New Patient Appointment

Request a New Patient Appointment
Dr. Emick's testing therapy schedule is usually full. However, at any given time, she may have an opening in her schedule.
Name of person requesting the appointment*

First NameLast Name
Name of person for whom the appointment is being requested, if not yourself

First NameLast Name
Date of birth of the person for whom you are requesting the appointment*

MonthDayYear
Email address at which you can be contacted*
example@example.com
Telephone number at which you can be contacted*
Please enter a valid phone number.Format: (000) 000-0000.
Neuropsychological assessment (requires a referral from your healthcare provider)Psychotherapy
Please provide additional information*
Please select your insurance plan from the list below. If your plan is not on the list, please call the office to determine whether Dr. Emick accepts your plan. Dr. Emick does not accept Medicare Advantage Plans, even if they are offered by any of the insurance carriers on this list.*
Please provide your Member ID.*
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.
DateTime*
Please verify that you are human*
Should be Empty: