CONTACT US Request An Appointment With the Right Fit Provider Answer a few questions to help us get to know you and we’ll contact you within 1 business day.If this is an emergency, please call 911. We’ll contact you within 1 business dayPlease Reach Out To request an appointment, use the form below, or call 513-204-1910 during business hours.Name(Required) First Last Email(Required) Date of Birth MM slash DD slash YYYY Gender as Indicated on Birth Certificate or on Insurance (to Make Sure Insurance Covers All the Benefits You're Entitled to)(Required)MaleFemaleBest Phone Number to Reach YouMethod of PaymentInsuranceSelfInsurance Carrier Please select up to three reasons for requesting an appointment Addiction Adjustment disorders Agoraphobia Anorexia and other eating disorders Anxiety Attention deficit disorder (ADD) Attention deficit hyperactivity disorder (ADHD) Autism spectrum disorder Bipolar disorder Bipolar II disorder Bulimia and other eating disorders Cognitive disorders Conduct disorder (pediatrics) Dementia Depression Developmental disorders (pediatrics) Disruptive mood dysregulation disorder (pediatrics) Gender dysphoria Gender identity concerns Generalized anxiety disorder Insomnia and other sleep disorders Major depressive disorder Mood disorders and thought disorders Obsessive-compulsive disorder (OCD) Oppositional defiant disorder (pediatrics) Panic attacks Post-partum depression Post-traumatic stress disorder (PTSD) Psychosis Schizoaffective disorders Schizophrenia Sexual identity concerns Substance use disorders Tic disorders Trauma Just want to talk to a professional about medications Do you have a specific Lee Side provider you'd like to see?YesNoName of Provider Do you have a preference for the gender of the provider?MaleFemaleNo Preference
