REQUEST A PRIVATE CONSULTATION Private Fit Call (15 minutes) Request Initial Evaluation return to top Future Psychiatry Intake Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Care Pathway Selection – Which level of care are you seeking *Telepsychiatry care New York StateIn-home concierge care ManhattanNot sure – open to recommendationSection 2 – Primary Concerns – What best describes your current concerns *Persistent sleep disruptionCognitive fatigue or brain fogBurnout or chronic stressMood instability despite prior treatmentDifficulty sustaining focus or performanceI've tried multiple approaches and want deeper evaluationSection 3 – Prior Care Context – Have you previously worked with psychiatry or therapy *YesNoBriefly – What has not worked so far *Section 4 – Practical Fit – Preferred timeline *As soon as possibleWithin 2–4 weeksExploring options Section Have Primary Availability *Weekday daytimeEveningsFlexibleSection 5 – Pricing Acknowledgment – Future Psychiatry is a private direct-pay practice. *I understand and am comfortable with the pricing of the selected care pathway.Section 6 – Contact Information – Full Name *FirstLastEmail *EmailConfirm EmailSubmit Request
