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Future Patient Information:
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Contact Information:
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Appointment Information
What is the primary reason for the appointment?
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Preferred Clinician
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Is there history of psychiatric hospitalization?
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Is there history of psychiatric medication?
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Is there need for psychiatric medication?
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Is there need for substance abuse treatment?
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Is there any or expected litigious case management?
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Is this the first time seeking psychotherapy treatment?
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Scheduling:
Please fill out all days of the week you are available to meet for weekly appointments. Typically, all of our patients attend weekly appointments with our clinicians and selecting as many possible openings will speed up the time to get an appointment. Appointment will only be offered for timeframes noted below. If there is no matching availibilty,
Availability:
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Sunday
Monday
Tuesday
Wednesday
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