Bright Path: Request an Appointment
Share your contact details and preferences so we can call to schedule your assessment.
Tell us how to reach you and we'll get back to you to set up your first visit. Please don't include medical or clinical details here. If this is an emergency, call 911. If you're in crisis, you can call or text 988.
Who is this request for?
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Myself
My child or teen (I'm their parent or guardian)
Someone else in my care
Your full name
*
First Name
Last Name
Name of the person who needs care
First Name
Last Name
Their age group
*
Under 18
18 or older
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Best time to call
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Morning
Afternoon
Evening
Any time
Is it OK to leave a voicemail?
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Yes
No
Which program are you interested in?
Please Select
Outpatient Treatment
Intensive Outpatient (adults only)
Day Treatment (children and teens only)
Case Management and Services Coordination
Medication support (teens and adults)
Not sure yet
Visit preference
Telehealth
In our office (by appointment)
No preference
Preferred language
I understand this form is not monitored for emergencies. If I'm in crisis I will call or text 988, or call 911.
*
I agree
Send request
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