Skip to content
Phone
Location
Book an Appointment
386-848-8751
1800 Pembrook Dr, Suite 300 Orlando, FL 32810
Book an Appointment
Patient Portal
Virtual Visit
Treatments
ADHD
Medication Management
Psychiatric Services
Anxiety
Depression Treatment
Bipolar Disorder
Therapy Services
OCD Treatment
PTSD Treatment
Anger Management
Virtual Counseling Services
Grief Counseling Services
Therapy
Depression Therapy
Bipolar Disorder Therapy
OCD Therapy
Cognitive Behavioral Therapy
Couples Therapy
Concentration and Focus Therapy
Blog
Pricing
Team
Locations
Aloma
Altamonte Springs
Apopka
Casselberry
Fairview Shores
Lake Mary
Lockhart
Maitland
Orlando
Oviedo
Pine Hills
Richmond Heights
Wekiwa Springs
Winter Park
Psychiatric Evaluation
(386) 848-8751
Patient Portal
Virtual Visit
Treatments
– Virtual Counseling Services
– ADHD
– Medication Management
– Psychiatric Services
– Anxiety
– Depression Treatment
– Bipolar Disorder
– OCD Therapy
– OCD Treatment
– Anger Management
– PTSD Treatment
– Grief Counseling Services
Therapy
– Therapy Services
– Bipolar Disorder Therapy
– Depression Therapy
– Couples Therapy
– Cognitive Behavioral Therapy
– Concentration and Focus Therapy
Pricing
Team
Blog
Locations
– Aloma
– Altamonte Springs
– Apopka
– Casselberry
– Fairview Shores
– Lake Mary
– Lockhart
– Maitland
– Orlando
– Oviedo
– Pine Hills
– Richmond Heights
– Wekiwa Springs
– Winter Park
Get Started
Psychiatric Evaluation
Request
Appointment
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
Preferred Service
*
Psychiatric Services
Therapy
Medication Management
Next
Do you have a specific mental health condition you'd like to address? (Select all that apply)
*
Depression
Anxiety
Bipolar Disorder
ADHD (Attention-Deficit/Hyperactivity Disorder)
PTSD (Post-Traumatic Stress Disorder)
OCD (Obsessive-Compulsive Disorder)
Schizophrenia
Eating Disorders
Other (Please specify):
Psychiatric Services (other)
What symptoms or issues are you experiencing that you would like to address in therapy? (Select all that apply)
*
Depression
Anxiety
Trauma/PTSD
Relationship Issues
Stress Management
Grief or Loss
Anger Management
Self-Esteem Issues
Eating Disorders
Other (Please specify):
Therapy (other)
Please list the names of any medications you are currently taking or interested in:
*
<div class="repeater-field-header wpforms-repeater-field-medium"> <div class="repeater-field-header-title">Medication <span class="repeater-field-header-count">1</span></div> <div class="repeater-field-header-acctions"> <ul> <li><i class="repeater-icon icon-down-open repeater-field-header-acctions-toogle" aria-hidden="true"></i></li> <li><i class="repeater-icon icon-cancel-1 repeater-field-header-acctions-remove" aria-hidden="true"></i></li> </ul> </div> </div>
Previous
Next
Preferred day of the week to see a provide
*
Previous
Next
Would you like to use insurance or opt for self-pay?
Insurance
Self-pay
Previous
Next
Your Information
*
First
Last
Phone
*
Email
*
Name of insurance provider
*
Name of insured
*
Date of Birth of insured
*
MM
1
2
3
4
5
6
7
8
9
10
11
12
DD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YYYY
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Member ID#
*
Submit
