Contact Request an Appointment Please note that this form is to be used for non emergencies only. We ask that you allow our office 48 business hours to contact you back. Thank you! Name* First Last Phone*Email* What service are you inquiring about?Select...Psychiatric MedicationCounselingGenetic TestingEMDRAre you a New or Existing Patient?*Select...New PatientExisting PatientRequested Appointment Date* Date Format: MM slash DD slash YYYY CAPTCHANameThis field is for validation purposes and should be left unchanged.