Information on individual in need of treatment:
The Anxiety Disorders Center does not accept state funded insurance such as HUSKY, Medicaid, and Title 19.
Who should we contact regarding this form?
Current Symptoms / Treatment
Are the following present?
Have you ever been diagnosed with or had problems with the following:
Past Treatment History
(If you require regular weekly appointments after 3PM, there may be an additional wait time to schedule your initial evaluation.)