Common Concerns
Individual Mental Health
Group Therapy
Couples and Family Therapy
Trauma
LGBTQIA | Gender Non-Conforming
Alternative Family & Relationship Structures
Painful or Dissatisfying Sex
Kink | Fetishes | BDSM
Meet The Team
Prescribing
Community
Resources
Work With Us
Org Development
CH Clinicians
Client Logins/Forms
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Menu
Common Concerns
Individual Mental Health
Group Therapy
Couples and Family Therapy
Trauma
LGBTQIA | Gender Non-Conforming
Alternative Family & Relationship Structures
Painful or Dissatisfying Sex
Kink | Fetishes | BDSM
Meet The Team
Prescribing
Community
Resources
Work With Us
Org Development
CH Clinicians
Client Logins/Forms
Rates
Contact
NEW CLIENTS: PRESCRIBING
Thanks for your interest in our prescribing program!
A Little Info.....
*
Indicates required field
Name
*
First
Last
Email
*
To get scheduled we have some questions below but before we get started, what’s bringing you in?
*
Please upload a photo of your insurance card if you intend to use insurance
*
Max file size: 20MB
Please upload a photo of your current ID
*
Max file size: 20MB
Some quick questions....
Are you currently seeing a behavioral health clinician?
*
Yes
No
Are you currently being seen or have you ever been seen at Cedar Hill?
*
Yes
No
If yes, by which Cedar Hill provider(s)
*
Have you seen a primary care physician within the last 12 months?
*
Yes
No
Please list any previous medical or mental health diagnoses you've received (please list all though we will focus on those that feel both current and accurate to you)
*
Are you currently taking any controlled medications? If yes, please list and indicate for how long
*
Are you currently taking any NON-controlled medications or supplements? If yes, please list and indicate for how long *
*
If you are currently taking any medications, who is your current prescriber?
*
If you are under the care of a behavioral health clinician, prescriber, or primary care doctor, is there any reason your prescriber would be unable to contact your current providers for care coordination, if needed?
*
Is there any reason why you could not be seen in-person, if needed?
*
And Lastly, Safety Check....
Have you ever been hospitalized for psychiatric or behavioral health reasons?
*
Yes
No
Are you currently mandated to receive psychiatric care?
*
Yes
No
Do you feel you are unsafe or is there a possibility you may harm others without immediate assistance?
*
Yes
No
Please Note:
Cedar Hill Therapy LLC and Kinship LLC are not emergency care providers. If you believe you or another are at risk for harm, please call 911 or text the
Crisis Text Line which offers free 24/7 help to those in crisis.
T
ext MN to 741741
Have you ever been terminated by a previous clinic or prescribing clinician?
*
Yes
No
If yes, please explain:
*
Please hit the submit button below and a prescriber will be contacting you shortly.
Note: please check your email SPAM folder if you have not received a prescriber response within 48 hours
Submit
Common Concerns
Individual Mental Health
Group Therapy
Couples and Family Therapy
Trauma
LGBTQIA | Gender Non-Conforming
Alternative Family & Relationship Structures
Painful or Dissatisfying Sex
Kink | Fetishes | BDSM
Meet The Team
Prescribing
Community
Resources
Work With Us
Org Development
CH Clinicians
Client Logins/Forms
Rates
Contact