Schedule An Appointment Form

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We are currently accepting ages 12-17 for ADHD evaluation and management and ages 18+ for all psychiatric needs. If you need assistance, please call 512-360-8488 and we will return your call.
Patient's Name*

First NameMiddle NameLast Name
Birth Date*

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Patient's Mobile Number*
Address*

Street Address

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Postal / Zip Code
Patient's Email (not the person completing this form if other than patient)*
If other individual completing the form, the name of the person completing the form, relationship and contact information.
How did you hear about BrainWell Psychiatry?*

Insurance companyReferral by another provider (primary care, therapist, etc).GoogleSocial/print mediaWord of mouthOther
If you were referred by another provider, please indicate by whom.
Main concern(s)?*
Services I am interested in:

Psychiatric evaluationMedication managementTMS (Transcranial Magnetic Stimulation)SpravatoADHD evaluation
BrainWell Psychiatry specializes in providing comprehensive psychiatric evaluations and medication management services, which include elements of cognitive behavioral therapy in each appointment. To address the high demand for psychiatric care in our area, our practice is focused on supporting patients who require medication and/or supplements as part of their treatment plan. For patients needing more frequent or intensive therapy sessions, we assist in connecting you with a therapist who can meet your specific needs. .*

I am not seeking only therapy.
Please select your insurance status.*
My insurance plan is *
If your insurance plan is accepted by our office, please provide your ID number so we can verify benefits. If you have no insurance or if your plan is not accepted by our office, please enter 0.*
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