Greenwich Child & Adolescent Psychiatry

Greenwich Child & Adolescent Psychiatry Send Message

Who would be receiving care?

Someone else

Your info

First name

Last name

Phone

Reason for care

What concerns are bringing you to seek care at this time?

Anxiety ADHD/Attentional difficulties Behavioral issues Mood/Depression Neurodivergence Disordered Eating/Nutrition Athlete/Performance Concerns Parenting Support OCD Other

What kind of care is being sought?

Psychotherapy Medication Both psychotherapy and medication Neuropsychological testing Diagnostic clarification/ Second opinion Parenting support Athlete/ Sports performance coaching Not sure

What mental health treatments 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 Treated for a neurologic or genetic disorder None of these apply

Has your child had any of the following recently?

Thoughts of harming themselves or others Self-injurious behavior (cutting, burning, etc.) Suicide attempt None of these apply

Is there any immediate safety concern right now?

Yes No

Client Preferences

Is there anything that the practitioner needs to know?

For example: what you'd like to focus on, referral questions etc.

Limited to 600 characters

Billing & Payment

I am aware that this practice does not accept commercial insurance and operates on a private-pay model (Superbills provided)

Yes

If you or others are in immediate danger or experiencing a medical emergency, call 911 immediately.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice.