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Welcome! Please tell us who are you seeking care for today?Fort Health treats young people ages 4-24.
I am a caregiver scheduling care for my child
I am between 18 and 24, looking for care for myself
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Which state do you live in?
New Jersey
New York
Pennsylvania
Texas
Illinois
I'd like to be notified when Fort is in my state
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Did your pediatrician or primary care doctor refer you to Fort?
YESNO
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Who is your pediatrician?* This field is required.
Pediatrician's name
Pediatric practice name
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Please tell us which of these symptoms bring you here today* This field is required.Your answers are confidential. These questions will not produce a diagnosis, but let us to determine how to help.
Academic or school problems
Anxiety or worries
Depression or sadness
ADHD or attention difficulties
Disruptive or defiant behaviors
Grief and loss
Social media and healthy screen behaviors
Sleep problems
Concerns about body image
Social problems or challenges making and keeping friends
Traumatic or stressful life experience
Using alcohol, illegal drugs or other substances
Autism/ASD
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Are you seeking treatment for autism? Fort welcomes patients with autism and treats many co-occurring challenges for autistic patients like depression and anxiety, but we don't offer treatment for autism.* This field is required.
I understand
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Please tell us if any of these experiences apply:Your answers are confidential. These questions will not produce a diagnosis, but let us to determine how to help.
Hospitalization for mental health concerns within the last six months
Suicide attempts within the last six months
Violent behavior leading to safety concerns for the patient or others
Disordered eating, behaviors like vomiting and binging, or an intense fear of weight gain
Using medication not prescribed to them, or taking too much of their own medication
Having so much energy that they don't seem to need to sleep
Hearing or seeing things that other people don't see or hear
None of the above are applicable
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If your child has thoughts of self harm and you are concerned for their safety, please call emergency services immediately. You may call 1-800-273-TALK (8255) to reach the National Suicide Prevention Lifeline, or text 741741 to reach the Crisis Text Line. If your child experienced suicide attempts or hospitalization within the last 6 months, your child likely needs another form of in-person care and we encourage you to speak to your pediatrician for additional referrals. * This field is required.
I will speak with my doctor for referrals for in-person care for my child
I have more questions and I'd like a call from Fort
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Thank you for informing us. The symptoms you entered require a different type of care than Fort can provide. We recommend locating your nearest in-person child and adolescent behavioral health practice and speaking with your child's pediatrician for additional support and referrals. If you have further questions for us, we can schedule a time to call you and discuss.* This field is required.
I will speak to my doctor to find the right care
I'd like a call from Fort
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Thank you for informing us. Disordered eating concerns require a different type of care than Fort Health can provide, but our partners at Equip Health may be a great fit for you. If you have further questions for us, we can schedule a time to call you and discuss.* This field is required.
I will contact Equip at www.equip.health, or talk to my doctor for additional referrals
I'd like a call from Fort
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What is your child's name?
First Name
Last Name
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Please select your child's age group:Fort Health treats young people aged 4-24. We match the patient's age to our clinicians' areas of expertise.
4-8
9-12
13-17
18-24
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We're glad you're here. What's your name?
First Name
Last Name
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Are you scheduling a therapy or medication management appointment?Most patients start with a therapy session, but some are referred directly for medication.
Therapy
Medication
Both
I'm not sure
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What State do you live in?
Please Select
Please Select
New Jersey
New York
Pennsylvania
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Your insurance networkThis allows us to find in-network providers
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Please provide your insurance cardThis lets us more accurately calculate costs
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Back of card
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Front of card
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Back of the card
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Great. Now what's your name?Please provide a legal caregiver we can contact to schedule care.
First Name
Last Name
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Please provide availability for an evaluation appointment (you and your child attend together).Please list days and times
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Please provide availability for weekly recurring therapy appointments (your child attends alone). Please list days and times
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Please list your availability for an initial evaluation session, and for recurring weekly sessions.We are able to schedule sessions most quickly prior to 3:30pm. Please let us know if you're available during this time.
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When can we call you to schedule your appointment?If the below doesn't fit your schedule, enter your preferences on the next page
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When can we call you to discuss further?
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How can we get in touch?Tell us a time to call, or whether you prefer to correspond by email
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Your NameWe're looking forward to speaking with you
First Name
Last Name
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Your Email* This field is required.
example@example.com
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Your Phone* This field is required.
Please enter a valid phone number.
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Lastly, who referred you to Fort?* This field is required.Please let us know the name of your Pediatrician or school counselor if they referred you.
33
We'll contact you as soon as we're in your state:
Your state
Your insurance network
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Lastly, how did you hear about Fort?* This field is required.
Please Select
Please Select
My pediatrician or primary doctor
My school
A Fort Health webinar
From a friend
Online search
Child Mind Institute
How did you hear about Fort?
Who is your pediatrician?
Pediatric practice name
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Please tell us the school and individual who referred you* This field is required.
Your school
Counselor or contact who referred you
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Timer
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Please verify that you are human* This field is required.
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