Assessment Scheduling

For outpatient assessments, schedule directly online here.

To request an inpatient assessment, fill out the form below and click here to download the Authorization to Release Protected Health Information form.

In case of a mental health crisis, CALL 988 or seek the nearest emergency room.

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Name*

Phone*

Email*

Check-In Time*

Date*

Why are you seeking an assessment?*

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I have read and agreed to the Disclaimer.

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I have read and agreed to the Privacy Policy.

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I understand for Hickory Trail Hospital to hold my reservation time, I must print & fill out the forms provided above, & bring them with me to my appointment.

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Admissions

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