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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 only be charged for missed appointments and secures your time on the schedule. If you do not show for your initial appointment your card will be charged $225 follow up apt no shows are $75. 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.