Please allow us to thank you for choosing Mid Cities Psychiatry for your mental health needs.

Please know that in order to provide the best possible service to you, it is necessary for you to complete the form at least 48-72 business hours before your appointment. This will allow us to understand your needs and requirements in a comprehensive and complete manner, which will enable us to provide you with holistic service. By completing the form in advance, you are helping your provider prepare for your appointment and ensure that they have all the necessary information to serve you better.

Kindly, fill out the form below in its entirety and click submit at the end. The form will take approximately 15-20 minutes to complete. If you are unable to complete then you may select the save and continue later button and a link will be sent to your email address to finish your partially completed form at your convenience.

If this form is not completed and submitted, we will not be to assist you or schedule an appointment… If you are unable to complete the form electronically, please call our office at 817-488-8998 ext 2 or e-mail us at, we can e-mail the form to your e-mail address.

Please Note: To Use the “Save and Continue Later” option, you may have the upload your Insurance Card if you have insurance and your Driver’s License again.

Please allow 24 business hours for us to get back to you.

Your needs are very important to us, in case you don’t hear from us within 24 business hours, please contact us at 817-488-8998 ext 2 or e-mail us at