NEW PATIENT APPOINTMENT | Magnolia Psychiatry

Provider Preference:

Full Name

Birthday

Month

Day

Year

Phone

Email

Multi-line address

Country/Region

Address

City

Zip / Postal code

Insurance Carrier

Policy Number

Group Number

List All CURRENT Medications:

List All PREVIOUS Medications

Reason For Appointment:

Date of Last Use:

Who Referred You To Us?

After submission, a member of our staff will enter your information into the system and cross-check your prescription history with the State Controlled Substances Monitoring Program. Any persons found to have "doctor-shopping" behaviors or suspected misuse of prescription medications, will not be allowed to schedule an appointment.

After approval, you will receive a text/email with a link to complete new patient paperwork and sign a consent for treatment. THIS MAY TAKE UP TO 24 HOURS. Additionally, because of the high no-show rates in mental health, you will be asked to pay the co-pay / co-insurance fee required by your insurance company or private-pay fee at the time of scheduling. No appointments will be scheduled prior to completion of these steps. YOU MUST COMPLETE YOUR NEW PATIENT PAPERWORK WITHIN 48 HOURS.

Magnolia Psychiatry

New Patient Appointments

Listen. Heal. Grow.

Interested in Becoming a New Patient?

Complete the form below to request a new patient appointment.

Please note: Request does not guarantee approval as some clients will not qualify for services or will require a higher level of care.