About You:
What scenario below best describe you?
*
A new patient
A returning patient (last seen over 6 months ago)
An existing patient
What US state do you reside?
*
CT
NJ
NY
Other
Name
*
First Name(s)
Last Name(s)
Date of Birth
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Over 20 yrs old
Mobile Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
How can we support you at this time?
*
Medication Management These appointments are intended for evaluating, prescribing, and adjusting psychiatric medications. They are conducted by healthcare providers specializing in psychiatry and focus on your medication plan, side effects, and how medications are helping with your symptoms.
Psychotherapy (individual, couples, family) These appointments focus on exploring thoughts, emotions, and behaviors to help manage life challenges, address mental health conditions, or support personal growth. The sessions involve talk therapy (psychotherapy) and do not include medication prescriptions.
BOTH Medication Management and Psychotherapy
I am not sure yet
Other
How would you like to pay for your appointments?
*
Private-Pay/Out-of-pocket
via Health Insurance
Please advise the name of your insurance plan:
*
Your Appointment Preference:
Do you have a prefered Medication Managent provider?
*
Please Select
No preference. Earliest Available Appointment.
Dr Christine Naungayan (M.D)
Catherine Halasz (APRN)
Matthew Hylton (APRN)
Rosemary Mensah (APRN)
Ron-Marvin Alcantara (APRN)
Shirley Messina (APRN)
Vaishali Desai (APRN)
Do you have a prefered Psychotherapy provider?
*
Please Select
No preference. Earliest Available Appointment.
Ann Ayli Furrer (LPC)
Deirdre Comey (LCSW)
Elizabeth Greenberg (LPC)
Eva Pena (LPC)
Frances Vadas (LCSW)
Jean DeVincenzo (LCSW)
Marily Berndt (LPC)
Stacey Zanoni (LCSW)
Stefanie Mair (LCSW)
What type of appointment are you looking for?
*
Please Select
Online (Telehealth)
In-person
Either Online or In-person
Do you have an especific date in mind?
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
In case your preferable date is not available, please indicate what day and time slots below work best for you (you can mark as many as you want)
*
Rows
Mon
Tue
Wed
Thu
Fri
Sat
Before 10am
Before 12pm
12pm - 2pm
2pm - 4pm
After 4pm
After 6pm
Add any important information here:
Please verify that you are human
*
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