Meeting Links
Patient Portal Access

Patient Service Request Form and Portal Access

Established Patient Portal Access:

https://app.carepaths.com/

For new patients, upload your documents here:

Please enable JavaScript in your browser to complete this form.

Patient Info

Patient Name
Address

Emergency Contact

Name / Relationship

Insurance / Payment

Include Insurance ID Number, Group holder name and DOB or other payment method

Service Request Details

Describe reason for seeking care
Current medications / psychiatric history
Medication trials, hospitalization or treatment programs

Disclaimer and Acknowledgement

Please note: submission of this form does not create a provider-patient relationship. You will receive an email with available appointments as the providers' clinical availabilities. Due to the volume of requests, requests are reply as first-come-first serve basis.

Acknowledgement of Disclaimer