Beyond the Storm Behavioral Health - Rachel Murdock and Associates

Who would be receiving care?

My partner and me

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Reason for care

What is the reason for seeking care?

Anxiety Attentional difficulties Behavioral issues Depression Grief Relationship issues Substance use Trauma Other

Administrative

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Do you currently have more than one active health insurance plan?

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Client Preferences

Preferred appointment times

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Preferred clinician

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Is there anything that the practitioner needs to know?

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Monthly Newsletter (Marketing Communications)

Privacy Statement Your privacy is important to us. Your contact information will be used only for the communications you choose to receive. We do not sell, rent, or share your personal information with third parties for marketing purposes. You may update your communication preferences or opt out of email communications at any time (except for essential communications related to your care or account).

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For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.