Patient Intake
Holistic Mental Health Intake
This form helps our Psychiatric Mental Health NP understand your situation before your first visit. Takes about 5 minutes. Everything you share is HIPAA-protected.
If you are in crisis or considering self-harm, this form is not a substitute for emergency care. Please call 988 (Suicide & Crisis Lifeline) or 911 immediately.
Patient Information
What brings you here?
Which apply? (select any)
Have you had thoughts of self-harm in the past two weeks?
Insurance Eligibility Check
Quick — no surprise bills. Tell us which plan you carry and we'll verify your behavioral-health benefits before your first visit.Knowing your coverage up front reduces no-shows by 20–30% — that's why we ask.
Verification is courtesy and not a guarantee of payment. Texas Insurance Code § 1271.155 requires final benefit determination from your carrier; we'll share that with you in writing before your first claim is filed.