Premier Psychological Center, Inc - The First Choice in Family Care
 
Make an Appointment
 
To make an appointment within the next week or so, complete the following form.  In the Insurance section, please include your insurance ID#, date of birth, and insurance phone number (usually on the back of the card). Also, indicate the date and time you'd like to be seen. We will do our best to accommodate you and will send a confirmation email of your appointment or call you. We will also verify your insurance information and contact you if there are any issues.
 
If you cannot make a scheduled appointment, give us a courtesy call of at least 24 hours or you will be responsible for the time reserved for you.  If you need an appointment within the next few days, please call us.
 
Name:
Address:
Email:
Best phone # to call:
Tell us about the patient:
Adult
Child (under 18)
Insurance Information
Check all areas of concern:
Depression
Anxiety
Learning Difficulty
Anger/Aggression
Substance Abuse
Marriage/Couples Counseling
Briefly describe why you seek treatment
 
 
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