Appointment Request

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We are currently doing intake appointments using telehealth (video). When the Governor lifts the current State of Emergency, we will return to doing appointments in the office. You will be asked in the form below if you would like to go ahead and schedule an intake now, or be contacted when we return to the office.

Our appointment hours are 8 AM - 5 PM, Mon-Thurs, and vary by therapist. Afterschool appointments are extremely limited - if you require appointments after 3 PM we may not be a good fit for your family. **Please note that completing this form does not guarantee an appointment.**

This form is for use by potential clients/families only. If you are a third party who is interested in referring a client to us, please visit CampbellPsychPA.com/forms for a Referral Form. Thank you!

Contact Information

Client Information

We need to know the client's age, in order to assign an appropriate therapist. Date of birth also helps us to check insurance benefits.
Having your policy number enables us to check your mental health benefits, so that we can provide you with benefit information when we contact you.

Please note that this is a request for an intake appointment and does not guarantee an appointment. We will review the information you have provided to determine whether we have a therapist available who would be a good fit. Our Care Coordinator will be in touch soon.

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