GET STARTED

Take the first step by completing the

Preliminary Survey Assessment Form.

Getting started with medication management and counseling has never been easier.

Submit our 100% online preliminary assessment form to help us determine if our services are the right fit for you.

If you qualify, we’ll connect you with a provider and create a personalized treatment

plan tailored to your needs and goals.

Let's start off by covering some basic information:

First Name *

Last Name Initial *

What is your age? *

Pls select your sex : *

How do you hear about us? *

What is your email address? *

What is your phone number? *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

What County/City and State do you reside in? *

What types of services are you interested in?

Medication Management

Minor Non-urgent Care (Cash Pay Only)

Telehealth Services

How do you plan to cover your sessions? *

What are your main objectives or areas you'd like to address through our services? *

What are your preferred times for appointments?

Are you interested in Telehealth (virtual) sessions? *

Yes

I'm not sure yet

Is there any other general information you'd like to share with us?

By checking this box, I acknowledge that the information provided is accurate to the best of my knowledge. In addition, I consent to being contacted by A Healthy Mind for scheduling and further assessment. *

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