UpWell New Client Inquiry
Thank you for your interest in UpWell Psychiatry! 

We have appointments available with our highly-trained Psychiatric Nurse Practitioners (PMHNPs) available within 1-2 weeks. We provide medication evaluation/management with brief therapy - completing this form is the fastest way to secure an appointment and to make sure we are a good fit for your goals.

We serve clients 14+ located in Oregon and Washington. 

We don't provide therapy services without medication services. 

We DO NOT provide 1st time ADHD diagnosis. 

Privacy Policy: Our New Patient Form is HIPAA compliant (protects your information) and will never be shared with 3rd party. By providing my contact information to UpWell Psychiatry, I acknowledge and give my explicit consent to be contacted via email and/or SMS for the purposes of engaging in services. You may opt out at any time. 
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Full Name *
Email  *
Phone Number (by providing this, you agree to be contacted via SMS for appointment reminders. You may opt out at any time) 
Date of birth *
YYYY
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MM
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DD
Current state of residence (we can only see clients located in Oregon or Washington) *
I am interested in working with: *
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