Tell us how we can help. Our team will review your request and contact you about current availability, the appropriate service, and the best office for your needs.
This form is for routine requests only. Do not include diagnoses, medication lists, treatment records, or other detailed medical information. If anyone is in immediate danger, call 911 or go to the nearest emergency department. Call or text 988 for the Suicide & Crisis Lifeline. In Connecticut, dial 211 for free, confidential, 24/7 connections to local health, human, and community services, including mobile crisis services when appropriate.
OUT-OF-POCKET APPOINTMENTS
Book a self-pay appointment online
Self-pay appointments are available with approved members of the care team. Choose the appropriate service, clinician, visit format, and available time through the online booking page. Availability varies by clinician.
Insurance or general appointment request
Documents needed for intake
The office will request a current state-issued photo ID or driver’s license and clear copies of the front and back of your insurance card. Office staff will provide the approved secure method for sending these documents.
Do not attach identity or insurance documents to ordinary email or enter their numbers in the routine message field below.
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Prefer to call?
Rocky Hill
(860) 996-1569
Monday–Friday, 8:00 a.m.–5:00 p.m.
Later appointments are available with certain providers. Please call the office for further information.
West Hartford
(959) 240-0250
Monday–Friday, 8:00 a.m.–5:00 p.m.
Later appointments are available with certain providers. Please call the office for further information.
Submitting this form does not establish a clinician-patient relationship or guarantee an appointment. The office will confirm availability and next steps.