Request appointment | Crystal Clear Mental Health, LLC

What is the reason for seeking care?

Anxiety Attentional difficulties Behavioral issues Depression Grief Relationship issues Substance use Trauma Other

Do you have a history of substance abuse?

No Yes, in the past Yes, currently

Do you currently have a psychiatric prescriber?

No Yes

Have you had previous psychiatric providers?

No Yes

Have you ever been discharged or dismissed from a psychiatric practice?

No Yes

Are you currently prescribed any controlled substances for mental health or other conditions?

No Yes

Are you currently on any psychiatric medications?

You will be asked to list meds at the end.

No Yes, less than 5 medications Yes, 5 or more medications

Do you have a history of medication non-compliance (stopping meds on your own, not taking as prescribed)?

No Yes, occassionally Yes, frequently