Daya Mental Health Appointment Request

We will send intake paperwork to your email. Once this is complete, we will call to schedule. Any forms that are not complete will be deleted after 7 days and you will need to resubmit a new request form.

Daya Mental Health and Wellness

77 Central Ave Suite A Asheville, NC 28801

828-412-3330

First Name

Last Name

Email address

Phone Number

What concerns do you wish to see someone for?

Provider preference

Who do you have your insurance through?

BCBS, Tricare, United, Aetna, Cigna

Who referred you?

If no referral source- enter "self"

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