Request a Psychiatry Consultation

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Name

First

Last

Phone

How can our Psychiatry team support you?

Have you ever worked with a Therapist?

Do any of the following apply to you?

Anticipating treatment with controlled substances (e.g. stimulants such as Adderall, or benzodiazepines like Xanax, Klonopin etc)
Seeking substance treatment (e.g. Detox, Buprenorphine/Suboxone, etc.)
In need of clinician to sign Disability, FMLA, or legal paperwork
Recent psychiatric stay and/or hospitalization/rehabilitation
Recent suicide attempt or active thoughts of self-harm

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