Request appointment | Blackstone NP In Psychiatry PLLC

Request an appointment

Preferred appointment times

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Is there anything else you would like us to know before reviewing your request?

For example: what you'd like to focus on, insurance or payment questions, etc.

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Emergency Acknowledgment

I understand that Blackstone NP In Psychiatry PLLC does not provide emergency or crisis services. If I have a medical emergency I will call 911. If I have a mental health crisis I will call or text 988 or go to the nearest emergency department.

Yes

Permission to Contact

I consent to Blackstone NP In Psychiatry PLLC contacting me regarding scheduling, appointments, billing, and care coordination using the phone number and email address I provided.

Yes

Permission to Receive Text Messages

I consent to receive appointment-related text messages from Blackstone NP In Psychiatry PLLC. Message and data rates may apply. Consent is not required to receive treatment.

Yes

Acknowledgement

I understand that submitting this prescreening form does not establish a provider-patient relationship

Acknowledgement

I understand that submitting this form does not guarantee acceptance into the practice or an appointment

Acknowledgement

I understand that insurance verification is a courtesy and is not a guarantee of coverage or payment.

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.