New Client Request Form

submit a request to establish care with Dr. Stodard

Please correct the errors described below.

Please complete the following items as thoroughly and honestly as possible so that I may best assist you in meeting your wellness goals. Due to my intentionally small practice I accept new clients on a case by case basis according to fit with my practice model, specialty areas and current availability. In the event that I do not currently have new client availability or that your needs are best served by another provider/service, I will send you that information directly.

Need immediate support?

If you are in crisis or need immediate support, call or text 988 to reach the National Suicide & Crisis Lifeline. Trained counselors are available 24/7 to provide support and connect you to resources if necessary.

If you need assistance managing a behavioral or mental health crisis contact The Mobile Response Team (MRT) which provides 24/7 intervention and support to all individuals in Escambia, Santa Rosa, Okaloosa and Walton Counties. Call 866-517-7766. The team will assess your concerns via phone triage and can dispatch a team to your location if needed.

If you are experiencing an emergency, call 911 or go to the nearest emergency department.

Your information will be encrypted.