Book an Appointment — Blueprint Integrative Mental Health

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Please fill out this brief survey and I will contact you within 48 business hours!

Self Pay: Initial Evaluation: $250 | Follow up: $145 (30 min) $100 (15 min)

Age range: 6 yo and older

In-Network:

Cigna—Aetna—Optum/United Healthcare/UMR—Blue Cross Blue Shield—VACCN—ComPsych—Magellan

Please select Provider you are requesting appointment with

Please select Insurance or Self Pay

Name

First Name

Last Name

Date of Birth

mm/dd/yyyy

Phone

(###)

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Reason for appointment request?

Please include a brief description of how I can help and what you're looking for in terms of mental health treatment.

Previous psychiatric diagnoses? (what have you taken meds for in the past, if any)?

Have you ever been treated for depression, anxiety, ptsd, schizophrenia, substance use, suicidal thinking, etc..?

Are you pregnant or planning to be?

Current Medications?

Please list all prescription and over the counter meds you take.

Have you ever been hospitalized in a mental health hospital for longer than 1-2 days?

If yes, list the month/year of your hospitalizations.

Put N/A if not applicable

We offer psychiatric medication management services. We are not a crisis/emergency/detox/MAT center.

If you are having a mental health crisis (active suicidal thoughts/plans, auditory and/or visual hallucinations, detoxing/withdrawing from substances): please call 911, or go to your nearest ER

How did you hear about Blueprint?

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Hours