Thank you for trusting Bravely Balanced Wellness with your mental health care.
This confidential intake allows your licensed psychiatric provider to better understand your medical history, current symptoms, treatment goals, and overall well-being before your evaluation.
Please answer each question as honestly and thoroughly as possible. There are no "right" or "wrong" answers. Your responses help us provide safe, thoughtful, and individualized care tailored to your unique needs.
Our commitment is simple:
Your information is transmitted securely and will only be reviewed by authorized members of your clinical care team in accordance with HIPAA privacy regulations.
Estimated completion time: 15–20 minutes
Thank you for allowing us to be part of your journey.
"We don't believe healing begins with a prescription. We believe it begins with being heard."
"He healeth the broken in heart, and bindeth up their wounds."
Psalm 147:3 (KJV)