Established Patient Portal Access:

https://app.carepaths.com/

For new patient, want to upload your documents?

Click on:   https://app.carepaths.com/

Enter:    Invitation Code: Zen-5089    to self register and upload documents

Service Request form

Patient *

First

Last

Gender

Date of Birth

SSN#

Address

Include full address with zipcode

Email *

Primary care physician (PCP)

Name/phone

Emergency Contact

Name/phone/Relationship

Method of Payment

Include Insurance ID Number, group holder name and DOB

What type of service are you seeking for?Medication ManagementPsychotherapyDiagnostic Evaluation

What is your chief concerns

Describe reason for seeking care

Current Psychiatric Medication History

Current medications/psychiatric history

Previous Psychiatric Medication History:

Medication trials, hospitalization or treatment programs

Please note: submission of this form does not create a provider-patient relationship. You will receive an email with available appointments as the providers' clinical availabilities. Due to the volume of requests, requests are reply as first-come-first serve basis.

your initial

Submit

Request for appointments online, at your convenience.