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Psychiatry

Any client 18 years or older needs to complete their intake forms in order for us to accept them. Please only complete one intake form per client. Thank you for choosing Think Happy Live Healthy.

Request a Psychiatry Appointment

Client Full Name

Name of person completing this form

Your relationship to client

Client Gender

Client Date of Birth

Client's Age

Cell Phone #

Current City & State You Reside

Email Address

Please be as detailed as possible and describe why you are seeking psychiatric services

Are you a current THLH client?

Yes

On waitlist

If not, are you currently/or plan to receive therapy services somewhere else?

Todays Date

Thanks for submitting! Please be on the lookout for an email from info@thinkhappylivehealthy.com within 24 hours. Please feel free to follow up with an email.