Southwest Regional Counseling
Southwest Regional Counseling
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Psychiatric New Patient Paperwork

Instructions

Please click on the links below and complete each  section.  You must fully complete parts 1-3 in order to be seen.  If you have any questions or difficulty filling out the forms please call our office at (276) 883-5050.


****Once you finish one section such as Medical Intake, you must go back and click on Psychiatric History, and so on until you complete all 3 forms.  ***

Medical Intake (1/3)
Psychiatric History (2/3)
Substance Use History (3/3)
  • Telemedicine
  • Opioid Use Forms
  • Psychiatry Forms
  • Online Meetings
  • FAQ

Southwest Regional Counseling, LLC

1114 E Main St Ste 4, Lebanon Virginia, 24266

(276) 883-5050

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