IMPORTANT: Submission of this prescreener is a request for consideration for services only. All information must first be reviewed to determine whether the prospective patient’s reported needs appear appropriate for the scope of Live Now Psychiatry. Completion or submission of this form does not guarantee acceptance into the practice, a screening call, consultation, appointment, evaluation, treatment, or prescription of any medication. A request may be approved or declined based on the information provided and the scope of the practice. Submission of this form does not establish a clinician-patient relationship. Live Now Psychiatry is not an emergency or crisis service, and this form is not monitored for emergencies. If you are experiencing a psychiatric or medical emergency, are having thoughts of harming yourself or another person, or feel unable to keep yourself or others safe, call 911 or go to the nearest emergency department immediately.

Please select the service that best describes what you are seeking. Selection of a service does not guarantee that the requested service will be offered or that you will be accepted into the practice.

Please answer based on your complete psychiatric history. Live Now Psychiatry does not specialize in or provide treatment for bipolar disorder, mania/hypomania, schizophrenia-spectrum disorders, psychotic disorders, or other conditions that fall outside the scope of the practice. Your responses are used to determine potential practice fit and do not constitute a psychiatric evaluation or diagnosis. Select “Unsure” if you do not know.

IMPORTANT SAFETY NOTICE: Live Now Psychiatry is a non-acute, outpatient psychiatric practice and is not an emergency, crisis, or acute-care service and does not provide 24-hour or on-call emergency monitoring. This form is not monitored for emergencies. If you are currently experiencing suicidal thoughts, thoughts or urges to harm yourself, feel unable to keep yourself safe, or believe you may require immediate psychiatric assistance, this practice is not an appropriate setting for your current needs at this time. Do not wait for Live Now Psychiatry to review or respond to this form and do not use this form or routine practice communications to request emergency assistance. Call 911 or proceed immediately to the nearest emergency department for an in-person emergency evaluation. Submission of this form does not constitute an emergency assessment, suicide-risk assessment, psychiatric evaluation, acceptance into the practice, or establishment of a clinician-patient relationship.

IMPORTANT SAFETY NOTICE: Live Now Psychiatry is a non-acute, outpatient psychiatric practice and is not an emergency, crisis, or acute-care service and does not provide 24-hour or on-call emergency monitoring. This form is not monitored for emergencies. If you are currently experiencing thoughts, urges, plans, or intent to seriously harm or kill another person, feel unable to keep another person safe, or believe there is an immediate risk of harm, this practice is not an appropriate setting for your current needs at this time. Do not wait for Live Now Psychiatry to review or respond to this form and do not use this form or routine practice communications to request emergency assistance. Call 911 or proceed immediately to the nearest emergency department for an in-person emergency evaluation. A past history disclosed on this form will be reviewed to determine whether the prospective patient’s reported needs are appropriate for the scope and level of care provided by Live Now Psychiatry. Submission of this form does not constitute a violence-risk assessment, psychiatric evaluation, acceptance into the practice, or establishment of a clinician-patient relationship.

Please answer based on your complete lifetime psychiatric history. This information is used to help determine whether your treatment needs and level of care are appropriate for the scope of this outpatient practice.

Please answer based on your complete lifetime history, even if a healthcare professional never formally diagnosed you. Live Now Psychiatry does not specialize in or provide treatment for bipolar disorder, mania/hypomania, schizophrenia-spectrum disorders, psychosis, or other conditions outside the scope of the practice. Your response is used only to help determine potential practice fit and does not constitute a diagnosis or psychiatric evaluation. Select “Unsure” if you are uncertain whether any of these experiences apply to you.