Schedule An Appointment

  • When requesting an appointment, please click on the download file here, complete this form and send it back to us.
    You may also fill out the online form below.  
  • A valid credit card is required for all commercially insured patients. This card will be charged for your evaluation and/or missed appointments and secures your time on the schedule. I hereby authorize Bancroft Behavioral Health, Inc. to charge the credit card listed for payment. I certify that I am a person who is authorized to use this card.