Initial Inquiry Form

This Initial Inquiry Form helps us understand your mental health concerns and treatment goals so we can determine if hormone-informed psychiatry is right for you. It takes just a few minutes to complete and ensures your first consultation is focused on your specific needs.

Name

Phone

What brings you to seek consultation at this time?

Have you had recent labaratory or endocrine evaluation?

Yes No

If yes, please provide details below.

What are you hoping to gain from consultation?

Which statements apply to your expectations? Check all that apply

I am seeking a careful, stepwise evaluation I am open to multiple possible explanations for my symptoms I understand that hormones may or may not be central

Are you currently working with?

How did you hear about the practice?

Details

Connect

Location

Dearfield Medical Building
4 Dearfield Drive
Greenwich, CT 06831

Phone

(203) 861-2654

Email

linusa@me.com