New Patient Intake Form

New Patient Intake Form

New Patient Intake Form

For new patient inquiries: please complete the intake/referral form in the document linked below.

Please select this link. https://forms.gle/gEUFjFhTC8yxjmEw8. 

Your information is securely protected on this server under our HIPAA and Data security agreements with Google. We will contact you directly within 48 business hours of your submission. After initial evaluations and official onboarding to our Electronic Health Record system, your information will be removed.
Related
Psychotherapy
Read more

Psychotherapy, or talk therapy, is a way to help people with various mental illnesses and emotional difficulties. Psychotherapy can help eliminate or control troubling symptoms so a person can function better and can increase well-being and healing.

Psychotherapy …

Psychiatric Evaluations
Read more

We work to improve the health and well-being of each patient as a whole by getting to the root causes of emotional distress and coming up with ways to improve mental health and restore functioning.

To determine the possible root cause of symptoms, a comprehensive …

Medication Management
Read more

Our Restoration Health and Wellness philosophy is based on our belief in holistic care. Each client’s treatment plan focuses on the body, mind, spirit, community, relationships, etc. We believe that medications should only be used when there is evidence to …

Send a Message

We would love to hear from you and help you take the next step toward improving your health and well-being, whether you're interested in learning more about our IV infusion formulas or behavioral health medication management. scheduling an appointment, or have a general question, we're here to help.

Get in Touch

Give us a call

(860) 479-1586

Send us an email

[email protected]
Social Media
Powered by