New Patient Forms & Online Intake
Please complete the secure online intake before your first appointment. The steps below explain what you’ll need and what to expect.
You will enter basic contact and demographic information, including:
- Legal name and preferred name
- Date of birth and sex assigned at birth
- Address, email, and mobile phone
- Emergency contact information
Please have the following ready when you begin the intake:
- Photo ID (driver’s license or other government ID)
- Primary insurance card (and secondary, if applicable)
You will be able to securely upload clear photos of the front and back of each card directly in the intake form.
If available, you may upload any recent psychiatric evaluations, medication lists, or hospital discharge summaries to help guide your care.
Don’t worry if you don’t have these yet – you can always bring them to your appointment or upload them later through the patient portal.
You will review and sign practice agreements, which may include:
- HIPAA & privacy practices
- Telehealth consent (for video visits)
- Financial and no-show policies
- Medication and controlled-substance policies (if applicable)
When you’re ready, click the button below to open our secure OptiMantra intake portal. The form usually takes about 15–25 minutes to complete.
- Complete all required fields (marked with an asterisk *).
- Upload your ID, insurance card(s), and any records you have.
- Submit the form. You’ll receive confirmation once it is received.