How to become a patient | Comprehensive Integrative Psychiatric located in Hingham and Duxbury, MA

SELF SCREENING TOOL FOR NEW PATIENTS

Thank you for your interest in PivotCare. In order to determine whether we are a good fit for your mental health needs, please answer the following questions in order to receive a New Patient Information packet. Included in this packet will be instructions on making your first appointment.

First Name (if you are looking for help for a minor please fill the minor's name) *

Last Name *

Date of Birth (if you are looking for help for a minor please fill the minor's date of birth) *

Pronouns *

Email Address *

Postal Code *

Phone Number *

What is the problem or goal for which you’re seeking guidance? *

Have you ever been hospitalized for a mental health diagnosis? *

Have you had any serious suicidal thoughts in the last 3 years? *

If you answered "Yes" to the above, please provide details. If you answered "No" then put "N/A" *

Are you looking for a consult or establish long term care? *

Our clinic has a unique advantage of having multidisciplinary team assessments. indicate the assessments. Please select the assessments you are interested in: *

Medication management

Herbal medicine

Functional medicine

Nutritional medicine

Neuropsychological and Academic testing

Psychotherapy

Ketamine Assisted Therapy

Health and wellbeing coaching

I am open to suggestions

We can provide multidisciplinary assessments online as well. Are you interested in seeking care: *

Online

In-person

Sometimes online and sometimes in person

If the patient is a child, are both parents in agreement that the child be evaluated and treated? *

Yes

Not applicable

More information about the above answer (optional) *

Who referred you to us? *

Please provide us additional details on the situation that brings you in for guidance, if medication management is involved please provide current medication and dosage. Please note that our practice does not prescribe benzodiazepines. Is there anything else about your mental health needs that you want us to know? *

Please check this box giving us permission to email or text you to help coordinate your care. *

Yes

Please note that does not provide behavioral health crisis services. If you are experiencing a crisis, please contact 911 for help.