Request an appointment. Name * First Name Last Name Email * Phone (###) ### #### I prefer to be contacted by: Phone Text Email Requested location In person - New Canaan Telehealth Do you have an official psychiatric diagnosis? Yes No Self-diagnosed Are you currently under the care of a psychiatric provider? Yes No Are you currently prescribed any psychiatric medications? Yes No Referred by If reaching out on behalf of another person, please indicate their name and relation below First Name Last Name Relation Child Step-child Spouse Friend Parent Other Thank you! Please note, your appointment is not confirmed until you receive notification back from us.
