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Contact Us
Fill out your details to get in touch with our team.
Parent's First Name
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Parent's Last Name
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Phone
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Email
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City
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State
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How can we help you?
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General Questions
Newborn Care
Lactation Support
Primary Care
ADHD
Autism
Asthma & Allergy
Anxiety, Depression, or Mood Issues
PANS/PANDAS
Behavioral Support
Developmental Evaluations
T1D Screening (Type 1 Diabetes Screening)
Second Opinions
Therapy (Mental Health, Speech, Feeding, Literacy)
Ear Piercing
Other
When are you due?
Where do you plan to deliver?
Ages of your child(ren)?
We often have a short waitlist for new primary care. Are there any acute healthcare needs we should be aware of?
Which are you looking for?
Seeking initial evaluation or diagnosis
Already diagnosed and looking for ongoing management
Tune Up Visit
Other
Where are things at with PANS/PANDAS right now?
Currently in a flare and need more acute care
In a stable place and need to establish care
How old is your child?
Please list any medications, herbs, vitamins, or supplements your child is taking.
What are the main concerns or challenges you're facing right now?
What are your main goals right now?
Which insurance coverage do you have?
Blue Cross Blue Shield (BCBS)
Aetna
United Healthcare (UHC)
Medica
Midland's Choice
Medicaid
Healthshare
No insurance
Which Medicaid Carrier Do You Have?
Molina
Total Care
UHC
Not Sure
Does your Blue Cross card say "BLUEPRINT" on it?
No, not blueprint plan
Yes, blueprint plan
Not sure
Notes and or specific questions we can answer?
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