Contact Us

Request an Evaluation

If you are a new patient seeking evaluation please start with this form.

We will be in contact with you within 1-2 business days.

Initial Agreements

By checking this box I agree this request is not an emergency or an urgent matter.

If this is a medical emergency, or you feel that you are at imminent risk of hurting yourself or others, please call 911 or head to the emergency room. The level of care provided by this clinic may not be able to meet your needs in this moment.

By checking this box I acknowledge that this clinic does not have in-person appointments, and am comfortable with participating in virtual appointments requiring microphone and video access

By checking this box I acknowledge that this clinic does not prescribe controlled substances.

A full list of waht is controlled a controlled substance can be found under "Our Services" or in the FAQ.

Patient Information

First name*

Last name*

Birthday*

Month

Day

Year

Email*

Phone*

Address*

Clinical Information

What kind of care are you looking for?*

Medication management (or considering it)

Psychotherapy

Not sure

Other (describe below)

What brings you in today? Give us a brief description of what led you to seek psychiatric care.*

Identification

Please provide proof of identification and copies of insurance cards if you have them. Images can also be emailed to admin@desertblossompsychiatry.com if you are having difficulties.

Government-issued identification

Insurance card (front)

Insurance card (back)

Referrals

How did you hear about us?

From a friend

Business card/advertisement

Online search

Doctor's office

Psychology Today

Insurance

Other

Work with Us

If you are a therapist, psychologist, or other healthcare professional please use the form below. Collaboration is always welcome.

First name*

Last name*

Email*

Phone

What brings you here today?

Desert Blossom Psychiatry

admin@desertblossompsychiatry.com

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