Schedule an Appointment — Treeline Psychiatry

It all begins with a conversation. Please fill out the referral form below so we can better understand your needs.

If you are in need of emergency care, call 911.

Current patients, please schedule through your patient portal.

Name

Date of Birth

Month/Day/Year

Email

Phone Number

Reason for Referral

Have you ever seen a mental health care provider?

Yes

No

If yes, who has been a part of your mental health care?

Are you currently taking any medications?

If yes, please list all prescription and over the counter medications.

Who is your primary insurance carrier?

How did you hear about Treeline?

Therapy /Medical Provider

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