Optimind Mental Health and Wellness Intake Request
Submit your information and staff will follow up.
Name
Phone
Email
State
Requested service
Psychiatric evaluation
Medication management
Follow-up
IOP
PHP
Residential Treatment
Unsure
Insurance company
Member ID / insurance number
Group number
Date of birth
Plan type
Unsure
Commercial / employer
Medicaid
Medicare
Marketplace
Self-pay
Anything else staff should know?
Submit Request