COMING SOON - BUT NOT ACTIVE YET...

**THIS FEATURE IS NOT ACTIVE AT THIS POINT IN TIME. PLEASE CALL OUR OFFICE AT 440.942.0100 TO MAKE YOUR FIRST APPOINTMENT**

If you are a new patient, you may use the following form to request an appointment for the person seeing the psychologist. We are requesting your insurance information on this form so that we can verify your coverage prior to making an appointment, and precertify your sessions with your insurance company when necessary. Once your insurance is verified, we will reply to your email address with a proposed appointment time and insurance coverage information.

Do NOT use this form if you are requesting a same day appointment, if you are a new patient, or if you are having an emergency. In the event of an emergency, contact 911. Use of this form indicates that you understand and agree to the following terms:

1. The use of email to request an appointment may not be confidential or secure. If you prefer, this information may be given over the phone.

2. We will attempt to offer an appointment time within the period requested. However, late afternoon or evening appointments may not be available unless you are already being seen in that time period.

3. Any appointment time that we offer is valid for 4 hours after we reply to your email request. If you do not confirm the offered appointment before the expiration of the 4 hour window, then the appointment will be automatically be made available to other patients. Once an appointment is offered by return email, you MUST confirm by return email or telephone voice mail acknowledging that you will take the appointment.

4. We will notify you if we cannot honor your appointment for the time requested due to prior scheduling commitments.