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Behavioral Health New Patient Screening

Please do not use this form if you are experiencing a crisis and are at risk of harming yourself or others, call 911 or go to your nearest Emergency Room for immediate assistance. You can also contact the Mobile Crisis Unit at 954-463-0911.

Before we begin, please note:

 

Our behavioral services and providers currently specialize in working with adults only (ages 18+). For pediatric resources visit Joe DiMaggio Children's Hospital.


The new patient screening/intake assessment is a required visit for admission to our clinic; it is not a visit to begin medications on the same day.

What services are you looking for?

If you are seeking services that we do not have listed, we suggest that you contact your insurance company to get a list of covered providers.

Patient Insurance information:

We will need the patient’s insurance information to determine if services are covered. If you don’t have insurance or services are not covered, we can offer a scholarship or self-pay rates to help make the services more accessible.

Contact Information

Please provide us with contact information. Our staff will review your information to make sure we are a good fit for you and contact you with any follow-up questions within one to two business days.

Representative Contact Authorization