Welcome

I understand that we do not provide urgent evaluations and wait time is based on the volume of requests and practice capacity.*

I understand that submission of this form do NOT guarantee an evaluation or acceptance to this practice*

I understand that this provider does not provide crisis care or urgent care. If I am experiencing an urgent or psychiatric emergency emergency, I need to seek immediate help through emergency resources such as 911 or the nearest emergency room.*

I understand that this practice does not provide treatment for substance use or substance abuse disorder. If concerns for substance use arise, I will be referred to an appropriate specialist or treatment program*

I understand additional health information and intake paperwork will be requested be for my initial evaluation.*

I understand to actively receive care; I must be residing in New York State. *

I understand that I may be contacted if additional information is needed to determine whether this practice is able to provide the appropriate level of psychiatric care and treatment for my needs.*

I understand after submission of this form, correspondence may take up to 72 hours. You will contacted by email.*