To apply for a new patient, please fill out and submit the form below.

Please digitally sign below to signify that:

You have been notified that for addiction treatment, we do not accept checks at the first appointment.


Office staff cannot guarantee that a specific medication will be prescribed. Requests for specific medications must be made directly to clinical staff.


You were notified that if they will be out of medications prior to their appointment with a prescribing staff, they must contact their prior psychiatrist/primary care physician for a refill.


If a family member called on behalf of an adult, they were notified that the prospective patient must call to confirm the appointment, otherwise it will be cancelled.


You were notified that intake appointments may be cancelled if prior medical/counseling records are not provided before or at the time of the intake appointment.