IP Consult

First Name *

Last Name *

Phone *

Email *

Date of Birth *

Street

City

State *

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip

Insurance Provider *

Aetna Alameda Alliance for Health Alignment Health Plan Alliance Health AmeriHealth Caritas Anthem Blue Cross Behavioral Health Systems Blue Cross Blue Shield (BCBS) Blue Shield of CA Carelon Behavioral Health (fka Beacon) Carolina Behavioral Health Alliance Cedars-Sinai Medical Foundation Cigna/Evernorth Community Health Group ComPsych EHN (Employers Health Network) Greater Tri-Cities Halcyon HealthPartners Health Plan of San Joaquin HMC Humana I Dont Know Kaiser Lucet Health Magellan Medcost Medicaid Medicare Medicare FFS (Traditional) MHN/HealthNet Molina Healthcare NC State Health Plan Networks by Design Not Provided Optum/UBH/UHC Oscar Other Partnership HealthPlan of CA Providence Affiliated Physicians (fka Axminster) Saint Johns Physician Partners SCAN Scripps Health Plan Self-Pay Sharp Health Plan SutterSelect Torrance Memorial IPA Tricare UMR/UHC VA WellCare TMS is not covered by Medicaid.

Other Insurance *

How did you hear about us?

Doctor Referral Mindpath Health Website Mindpath Behavior Health Outreach Specialist Former Patient Insurance Website Online Search Online Ad Online Article Psychology Today Radio / Streaming Social Media Friend / Family Employer / EAP School / University

What service are you requesting? *

Transcranial Magnetic Stimulation (TMS)
SPRAVATO® (esketamine)

By clicking submit, you agree that Mindpath Health may contact you by email, phone, or text.