Child & Adolescent (AGE 6-17) or Adult (AGE 18-22) Patients

Thank you for your interest in our practice. Please select the most appropriate ‘New Patient Visit Request’ below and complete the confidential screening form. We will review the information you provide and ensure our clinic is a good fit for your mental health needs. Please allow 5-10 business days for a response regarding scheduling and confirmation of your appointment. Once your information is reviewed, you will receive a phone call or email regarding next steps.

Please complete the most appropriate form below:

New Patient Visit Request

Age 6-17

New Patient Form (Age 6-17) - Payment method: HEALTH INSURANCE
New Patient Form (Age 6-17) - Payment method: PRIVATE/SELF PAY

Age 18-22

New Patient Form (Age 18-22) - Payment method: HEALTH INSURANCE
New Patient Form (Age 18-22) - Payment method: PRIVATE/SELF PAY

RELEASE OF INFORMATION FORM - In the state of Washington age of Consent is age 13+. If your child lives in the state of Washington and is between the ages of 13-17, then your child will need to complete the release of information (ROI) below allowing parent/guardian to communicate fully with Bravo Mind Psychiatry PLLC. This is needed prior to confirming/scheduling the first appointment.

Release of Information - Parent/Guardian in State of WA