Thank you for considering us for your mental health needs.
This confidential, encrypted form allows us to assess whether we can provide you with the high quality psychiatric care we strive to give every patient.

• Your initial consultation is a consultation appointment. It is not a guarantee for ongoing treatment and medications may not be prescribed.
• Exousia Behavioral Health believes in safe prescribing practices and prescribes controlled substances very judiciously and only when clinically indicated. There is no guarantee that benzodiazepines or other controlled substances will be continued or prescribed, unless deemed to be clinically necessary.
• A neuropsychological examination or satisfactory documented childhood records are required for Stimulant prescriptions in patients 18 years and above seeking ADHD treatment.

Please answer the following questions to the best of your ability. After submitting the form, we will contact you through email regarding next steps.
Submitting this form does not represent a doctor- patient relationship.