Appointment - IvyMed Behavioral Health, PLLC

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Strengthen relationships, enhance your life.

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Location
Contact

Home
About Us
Services

Specialties and Expertise

ADHD Disorder

Anxiety Disorder

Autism Disorder

Bipolar Disorder

Depression

Insomnia Disorder

OCD

ODD

Personality Disorder

Neurocognitive Disorder

Psychosis

Schizophrenia Spectrum

Counseling

Psychotherapy
Therapy Types

Treatment Approach

CBT Therapy

Change your thoughts, change your world.

Learn More

DBT Therapy

Balance emotions, build a life you love.

Learn More

Existential Therapy

Discover yourself, find meaning, and live with purpose every day.

Learn More

Interpersonal Therapy

Strengthen relationships, enhance your life.

Learn More
Blog
Location
Contact

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Therapy Types
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Home
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Therapy Types
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Appointment Form

Appointment Form

Basic Information

Are you filling this form on behalf of an individual

Yes

No

Relationship

First Name

Last Name

Suffix

First Name

Last Name

Gender

Male

Female

Do not wish to disclose

Date of Birth

Primary Phone

Home

Mobile

Work

Email

Address

Address Line 1

Address Line 2

City

State

Zip Code

Marital Status

Demographics

Race

Preferred Pronoun

Primary Language

Emergency Contact

Relationship to Contact

First Name

Last Name

Primary Phone

Home

Mobile

Work

Email

Address

Address Line 1

Address Line 2

City

State

Zip Code

Financial Information

Responsible Party

Who will be financially responsible for you?

Myself

Someone else

Relationship to Contact

First Name

Last Name

Method of Payment

What will be your method of payment?

Insurance

Self-Pay

Primary Insurance Policy

Insurance Company

Insurance Plan

Policy Number

Group Number

Are you the Primary Policy Holder ?

Yes

No

Relationship to Primary Policy Holder

First Name

Last Name

Policy ID Number

Date of Birth

Secondary Insurance Policy

Do you have a secondary insurance policy?

Yes

No

Insurance Company

Insurance Plan

Policy Number

Group Number

Are you the secondary policy holder?

Yes

No

Relationship to Secondary Policy Holder

First Name

Last Name

Insurance ID Number

Date of Birth

Additional Information

Pharmacy Name

Pharmacy Address

Pharmacy Name

Pharmacy Address

How did you hear about us?

IvyMed Behavioral Health PLLC offers expert mental health care, including diagnostic evaluations, medication management, and personalized therapy for various conditions.

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Contact info

7300 State Highway 121, Suite 300 McKinney,Texas,75070
4500 9TH AVE NE, Suite 300 Seattle, WA 98105
+1 (844) 688-4866
scheduling@psychealth.clinic

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