Request appointment | Walsh Psychiatric Service, LLC (d/b/a) CalmPath Mental Health

Request an appointment

Payment method

How do you plan to pay?

Insurance Provider:

Primary Card Holder's Name/ Date of Birth/ Phone# ?Address if different from Client.

Limited to 600 characters

Insurance card upload

Upload a photo of your insurance card

How do you plan to pay for services?

Self-pay /private pay

Using insurance (please list plan) Not sure yet / need guidance

Payment & Card on File Policy.

A valid credit or debit card is required to be kept on File to request an appointment. Charges may apply per practice policy. Full details are reviewed and signed prior to your first visit.

I understand and acknowledge the Payment & Card on File Policy

If someone else is the Primary Insurance Subscriber (parent, spouse, guardian, etc.), please provide their full name and date of birth. Otherwise, enter "Self."

Name & Date of Birth of Primary Insurance Holder. And Your relationship to the Primary Insurance Holder.

Limited to 600 characters

Secondary insurance:

Do you have secondary insurance coverage?

No Yes : If Yes please provide additional insurance information below

Secondary Insurance Information (If Applicable)

Secondary Insurance Company Name. Member/ Subscriber ID. Group Number. Subscriber Name if Different from Patient. Subscriber Date of Birth. Your Relationship to Subscriber.

Limited to 600 characters

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