Thomas Michaels
English
English
Español
Request an appointment
Existing client?
Sign In
Reason for care
Select date & time
1
Appointment info
2
Prescreener
Reason for care
3
Contact information
What is the reason for seeking care?
Anxiety
Attentional difficulties
Behavioral issues
Depression
Grief
Relationship issues
Substance use
Trauma
Other
What mental health concerns or treatment have occurred in the past?
In therapy now
In therapy in the past
Taking psychiatric medication now
Taken psychiatric medication in the past
Hospitalized for mental health reasons now or recently
Hospitalized for mental health reasons in the past
Known neurologic or genetic disorder
Attempted suicide in the past
None of these apply
Are you currently experiencing thoughts of hurting yourself or someone else? (Please note responses to requests may not be seen for 24-48 hours and immediate health and safety concerns may be addressed by your nearest emergency room)
Yes, and the thoughts are recurrent and specific
Yes, but the thoughts are not specific in nature ("passive")
No
Have you been using alcohol or illicit substances daily for the past 14 days or longer? (Please note responses to requests may not be seen for 24-48 hours and immediate health and safety concerns may be addressed by your nearest emergency room)
Yes-alcohol
Yes-Illicit Drugs
Yes-A combination
No
If you or others are in immediate danger or experiencing a medical emergency, call 911 immediately.
Next
Next