Request appointment | Barnett Wellness Clinic

What is the main concern you are seeking help with?

Depression, Anxiety, ADHD, Behavioral Disturbances, Sleep Problems, etc.

What kind of care is being sought?

Medication Management Psychotherapy Wellness Coaching Supplement Guidance Unsure

What mental health concerns or treatment have occurred in the past?

In therapy now In therapy in the past Taking psychiatric medication now Taken psychiatric medication in the past Hospitalized for mental health reasons now or recently Hospitalized for mental health reasons in the past Known neurologic or genetic disorder Attempted suicide in the past None of these apply

How Long Has This Been a Concern?

Days Weeks Months More than a year

Do you have any urgent safety concerns today (such as thoughts of self harm)?

Yes No

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