New Patient Appointment Form Logo

  • New Patient Appointment Request

    If you are experiencing a mental health emergency or crisis, stop and call 911, the crisis line at 988, or go to the nearest emergency department.

  • Thank you for considering Ground Up Behavioral Health. We’re honored by your interest in scheduling an appointment. To help us understand how we can best support your mental health needs, please complete the form below.

    • Patient Information 

    • We may prescribe stimulant medications such as Adderall, or controlled substances like Klonopin, Ativan, Valium, or Xanax, only under very strict criteria and when clinically justified. These medications are used rarely and with great caution.

    • Out-of-network plans are eligible for reimbursement and we can provide a superbill/detailed receipt. We understand that there are specific subsidiary plans under the insurance carriers listed below that are not included here. Call us at 334.746.5586 or contact us here to see if we accept your insurance.

    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    • Patient/legal guardian Information 

    • We may prescribe stimulant medications such as Adderall, or controlled substances like Klonopin, Ativan, Valium, or Xanax, only under very strict criteria and when clinically justified. These medications are used rarely and with great caution.

    • Out-of-network plans are eligible for reimbursement and we can provide a superbill/detailed receipt. We understand that there are specific subsidiary plans under the insurance carriers listed below that are not included here. Call us at 334.746.5586 or contact us here to see if we accept your insurance.

    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    • Should be Empty: