Contact Us

Please fill out the new patient form below. If you have any questions, you can call us at 801-382-8238.

Your Name

First Name

Last Name

Phone

(###)

###

####

Email

Patient's Name

Leave blank if same as above

First Name

Last Name

Patient's Date of Birth

MM

DD

YYYY

Patient's Gender at Birth

Male

Female

Current Insurance Provider (if any)

Message

A brief description of what you or your child would like to be seen for.

Requested Services

Psychiatry & Therapy

Therapy

Psychiatry

Unsure

240 N. East Promontory, Suite 200, Farmington Utah 84025

Located at Station Park in the Regus Office Building

(801) 382-8238

Drop us a line. We are always looking to add top talent to our psychiatry and therapy teams.

First Name

Last Name

Email

Message