top of page

Medication Inquiry

Thank you for your interest in psychiatric care at Berkeley Therapy Institute, please answer the following questions so that we may more efficiently get you the care you are looking for:


PLEASE NOTE: 

  • Contact by email does not constitute a working therapeutic relationship or doctor-patient relationship.

  • This form is to be completed only by the person seeking services or by a parent for a minor child.

  • Under 'Services Requested' you may only select one option per inquiry, either 'Talk Therapy' and 'Medication Management.' If you want both, please submit two separate inquiries.

What symptoms/concerns bring you to BTI ?
Anxiety
Depression
Mood swings
Difficulty sleeping
Hallucinations
Irritability
Suicidal thoughts
ADHD assessment
ADHD treatment
Other
Do you

Are you currently experiencing a mental health crisis?

Are you currently experiencing a mental health crisis
Yes
No

If yes, please understand we may not be the appropriate level of care for you at this time, but we will do everything we can to help you find the care you need.

Have you ever been hospitalized for your mental health?

Have you ever been hospitalized for your mental health?
Yes
No

Do you have a current provider you are seeing for psychiatric care?

Do you have a current provider you are seeing for psychiatric care?
Yes
No

Do you have a current therapist?

Do you have a current therapist?
Yes
No
Do you have a preference for being seen in-person vs. remotely via telehealth?
Yes
No
Either

Are you hoping to see a particular psychiatric provider in our practice? We do our best to match patients with the psychiatric providers of their choosing, though this is not always possible due to insurance contracts or the availability of providers.


Our psychiatric providers who are currently taking new patients are:


●       Kalia Rothlind, Psychiatric Nurse Practitioner


●       Cris Bissonnette, Psychiatric Nurse Practitioner

bottom of page