New Client Evaluation

Click HERE for current insurance plans accepted and states served , and HERE for current policies.

Evaluations are reviewed during our normal business hours, Monday-Thursday 8AM - 4 PM CST (excluding major holidays). You will be contacted within one business day, regarding your submission.

Please double-check for accuracy: Spelling of first and last name, date of birth, and email address.

First Name

Last Name

Serving ages 18-65 (as stated under Policies).

Please provide a brief statement explaining why you are seeking treatment. If you have current, or previous, psychiatric diagnoses, please list them here:

Are you currently attending therapy/counseling sessions?

Yes

List: Current and previous psychiatric medications. Please also list all other currently prescribed medications.

Have you been hospitalized for psychiatric reasons? If yes, briefly indicate when, and why:

What insurance do you carry? (Please take the time to review home page for current plans accepted. If your plan is not currently accepted, and it's agreed to move forward, you will be responsible for paying full price for our services.)

We have received your submission. You will hear from us within one business day.

Kuponya

Telepsychiatry

Kuponya... - Swahili.... English translation, "healing; to heal"

New Client Evaluation

Click HERE for current insurance plans accepted and states served , and HERE for current policies.

Evaluations are reviewed during our normal business hours, Monday-Thursday 8AM - 4 PM CST (excluding major holidays). You will be contacted within one business day, regarding your submission.

Please double-check for accuracy: Spelling of first and last name, date of birth, and email address.

​

​

New Client Evaluation

Click HERE for current insurance plans accepted and states served , and HERE for current policies.

​

Evaluations are reviewed during our normal business hours, Monday-Thursday 8AM - 4 PM CST (excluding major holidays). You will be contacted within one business day, regarding your submission.

Please double-check for accuracy: Spelling of first and last name, date of birth, and email address.