- If you are experiencing a life-threatening medical emergency, please call 911 immediately or visit the nearest emergency room. Do not wait for a scheduled appointment or attempt to drive yourself to a hospital if you are facing a critical health crisis.
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- We apologize for the inconvenience, we only see patients 16 years of age or older.
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We apologize for the inconvenience, we do not specialize in these matters and we cannot make the appointment.
We apologize for the inconvenience, we do not specialize in these matters and we cannot make the appointment.
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Please contact our Appointment Team at
817-488-8998 ext 2 to further assist you.
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RCN (Rescheduling / Cancellation / No-Shows) Policy:
I acknowledge Mid Cities Psychiatry's policy for rescheduling, canceling, and no-shows. I must inform Mid Cities Psychiatry at least 24 business hours before my appointment for changes. Weekends, long weekends, and national holidays are excluded as they are non-business hours. Non-compliance will incur charges as per the RCN Fee Schedule:
- 40 minutes meds management appointment no-show fees would be $150.00
- Psychologists' appointment no-show fees would be $150.00 per hour
- Therapist's appointment no-show fees would be $150.00
- 20 minutes meds management appointment no-show fees would be $75.00
To avoid these charges, please reschedule or cancel in more than 24 business hours in advance, considering our office closure on weekends and holidays.
- Please click below to complete your intake form so we can verify your insurance benefits and schedule your new patient appointment.
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Please Note: There may be a slight delay of 1-2 minutes in processing your attachments based on their sizes. You're requested only to attach them once and wait for them to load.
Your understanding is greatly appreciated.
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Primary Insurance
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Please Note: There may be a slight delay of 1-2 minutes in processing your attachments based on their sizes. You're requested only to attach them once and wait for them to load.
Your understanding is greatly appreciated.
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Secondary Insurance
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Please Note: There may be a slight delay of 1-2 minutes in processing your attachments based on their sizes. You're requested only to attach them once and wait for them to load.
Your understanding is greatly appreciated.
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Suicidal Ideations (CCSR)
Immediate Steps for Your Safety
Based on the outcomes of your recent safety assessment at Mid Cities Psychiatry,
we urge you to take the following immediate steps:
If you need immediate help, please call 911.
or Visit an Emergency Room Near You
or Reach out to family or friends for support during this time.
or Contact the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255)
or text "HELLO" to 741741 for 24/7 confidential counseling.
For more information, visit our Patient Resources webpage.
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Homicidal Ideations
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PLEASE Go To Your Nearest Emergency Room or Call 911.
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Dependent Care Resources
Dependent Care Resources
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Psychiatric Advance Directive Question:
Psychiatric Advance Directive
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Legal Need Resources Question
Legal Need Resources
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Vocational Need Resources Question
Vocational Need Resources
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Generalized Anxiety Disorder Questionnaire ( GAD-7 )
- How often have you been bothered by the following problems? As you answer each question, select the radio button that best describes how you have felt and conducted yourself over the past 2 weeks.
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- Please make sure to submit your previous Connors (ADHD) Testing or Personality Assessment Inventory results soon after your appointment is scheduled
at Mid Cities Psychiatry. This field is hidden when viewing the form
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Rapid Mood Screener (RMS)
- Are you among the millions of people who have depressive symptoms? Answer the following questionnaire about your medical history so that it can be provided to your provider or nurse to assist in an important conversation about your mood. Please select one response for each question. You can complete the RMS in less than 2 minutes.
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Quality of Life Enjoyment and Satisfaction Questionnaire – Short Form (Q-LES-Q-SF)
- During the past week how satisfied have you been with your:
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PIF
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Previous Psychiatric Diagnosis
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- PPD-2
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- PPD-3
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- PPD-4
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- PPD-5
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Previous Psychiatric Hospitalizations and/or Rehabilitation
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- PPHR-1
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- PPHR-2
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- PPHR-3
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- PPHR-4
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Previous Psychiatric/Sleep Medications
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- PPSMM-2
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- PPSMM-3
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- PPSMM-4
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- PPSMM-5
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- PPSMM-6
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- PPSMM-7
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Medication Allergies
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- MA-2
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Pharmacy
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- Pharmacy-2
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Self Medical History
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- SMH-2
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- SMH-3
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- SMH-4
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- SMH-5
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- SMH-6
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Physical Pain
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Nutritional Status
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Self Psychiatric History
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- SPH-2
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- SPH-3
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- SPH-4
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- SPH-5
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- SPH-6
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Family Medical History
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- FMH-2
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- FMH-3
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- FMH-4
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- FMH-5
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- FMH-6
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- FMH-7
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- FMH-8
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- FMH-9
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- FMH-10
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Family Psychiatric History
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- FPH-2
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- FPH-3
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- FPH-4
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- FPH-5
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- FPH-6
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- FPH-7
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- FPH-8
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- FPH-9
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- FPH-10
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Past Surgical History
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- PSH-2
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- PSH-3
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- PSH-4
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Legal History
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- LH-2
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- LH-3
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Probation
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Lawsuits
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Court Dates
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Military Service
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Previous Substance Abuse
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- PSA-2
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- PSA-3
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Current Substance Abuse
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- CSA-2
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- CSA-3
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Nicotine
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- N-2
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- N-3
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- N-4
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Vape
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Drink
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Alcohol Screening Questionnaire ( AUDIT )
- Our clinic asks all patients about alcohol use at least once a year. Drinking alcohol can affect your health and some medications you may take. Please help us provide you with the best medical care by answering the questions below.
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Currently
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In the past
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Social History/Marital Status
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Social History/Sexual Orientation
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Gender
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Education
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Employment
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Physical Exam Self Assessment
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Current Stressors
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Hallucinations
- Hallucinations are defined as sight, sound, smell, taste, or touch that a person believes to be real but is not real. Hallucinations can be caused by nervous system disease, certain drugs, or mental disorders.
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Delusions
- A delusion is defined as a false belief based on incorrect inference about external reality that is firmly sustained despite what almost everybody else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary.
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Possession of Gun
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