AutoPsych Enrollment and Scheduling

Welcome to Enrollment and Scheduling.

Let's get started.
Online Initial Evaluation(30-50 minutes). Please pick a time that works best for you.*

Monday 1-6pTuesday 1-6pWednesday 12-5pThursday 5-10p
Contact Information
Please Enter Your Name*

First NameLast Name
Your Date of Birth*

MonthDayYear
Date
Your Email Address*
example@example.com
Your Phone Number*
Please enter a valid phone number.
Your Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Schedule Your Visit
Please select the preferred date and time for your online initial evaluation:*
Agree to Terms, Conditions, Privacy and Telehealth Policies
Patient Signature*

Clear
Submit Payment

Please submit payment to confirm your enrollment:*

New Patient EnrollmentEnrollment includes: Comprehensive initial evaluation, unlimited visits, unlimited prescriptions, automatic monthly prescription refills, and 24/7 access to care with our amazing provider team. Cancel anytime.

$499.99 for the first month then,$99.99 for each month

Enter coupon

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Welcome to Enrollment and Scheduling.

Contact Information

Schedule Your Visit

Agree to Terms, Conditions, Privacy and Telehealth Policies

Submit Payment