New Patients

If you are ready to become a new patient, please begin by completing the questionnaire below. Based on your responses, you may be taken to a screen to schedule your first appointment or be notified that we will contact you for further information. You will receive an estimate for cost of services based on your insurance plan prior to your first appointment. You may cancel with no charge as long as you provide at least 24 hours notice prior to your appointment start time.

If you’d like more information, you can call or text us at 412-467-6410 or email us at admin@balancepsych.org.

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Name *

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Email *

Preferred phone number *

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Have you ever used a telehealth platform before? *

Which telehealth platform? *

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We do not currently offer therapy services. At this time, we are only providing medication management and/or diagnostic services. *

I understand

What kind of care are you seeking? *

Psychiatric/Mental Health
Physical Health
Both

Is the person seeking treatment under the age of 18? *

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What is your primary state of residence? *

Alaska
Arizona
California
Colorado
Connecticut
Delaware
Florida
Idaho
Iowa
Maine
Massachusetts
Maryland
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Montana
Nevada
New Mexico
New Jersey
New York
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Ohio
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Pennsylvania
Texas
Utah
Vermont
Virgina
Washington DC
Washington
Wisconsin
Wyoming

*You must have a primary residence in and be physically located in one of the states our nurse practitioners are licensed in at the time of all of your appointments.

What is your primary state of residence? *

Florida
Oregon
Utah
Washington

*You must have a primary residence in and be physically located in one of the states our nurse practitioners are licensed in at the time of all of your appointments.

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What insurance plan do you intend to use (or self-pay)? *

Is your insurance a Medicare or Medicaid plan? *

Thank you for your interest. Douglas Ludington is our provider in network with Medicaid and Medicare but only in Utah. Shelby Dobrich is in process of becoming in network in Oregon for mental healthcare. To be contacted by our office staff, please click next then submit our form. If you have Medicaid but are not located in Utah or Oregon, you may want to try calling the customer service number on the back of your insurance to find in network providers. Federal guidelines do not permit us to accept Medicare patients as self pay.

We do not currently offer physical health services in this state. We offer psychiatric services only in this state.

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Do you currently have intent to end your own life? *

Please seek immediate assistance by calling 911, texting 741741 or calling the National Suicide Hotline at 988 or 1-800-273-8255.

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Are you seeking a prescription for a stimulant or benzodiazepine medication? *

Benzodiazepines
Stimulants
Both
Unsure
None

Please specify the medication name and dosing. *

We are not currently able to prescribe controlled medications in this state.

Please provide your date of birth below. *

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Do you have a history of being diagnosed with a psychotic disorder (such as schizophrenia)? *

Yes
No
Unsure

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Do you have a history of suicide attempts? *

Yes, 1
Yes, 2 or 3
Yes, more than three
No

When was your most recent suicide attempt? *

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Do you have a history of psychiatric inpatient or residential treatment stays? *

When were you discharged from your most recent residential or inpatient stay? *

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Are you seeking an evaluation for a specific form, work/academic accommodation, or surgery? *

What are you seeking an evaluation for? *

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What is your primary reason for seeking care for your physical health?

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Thank you for your interest in Balance Psychiatric Services. Be sure to hit SUBMIT below! We will be contacting you shortly for additional information. Please provide us with the best days/times and preferred contact method to reach you. If you'd like you can upload your insurance card below so we can check if we are in network prior to contacting you.

Thank you for your interest in Balance Psychiatric Services! Here are the next steps to setting up your first appointment:

Click on the link below to set up your patient portal.
Once you have set up the patient portal, please complete all of the new patient forms. You must complete all of the forms prior to scheduling your first appointment.
Once your intake forms are complete, you can request a date/time for your first appointment in the patient portal. Please be aware, your appointment is a request until confirmed by our office. If you cannot find a time that works for you, please reach out to us by calling or texting 412-467-6410 or by e-mail to admin@balancepsych.org.
Please your insurance card below. Alternatively you may send a copy (front and back) of your insurance card to admin@balancepsych.org or text to 412-467-6410. We will send you an estimated cost of services to your provided e-mail address prior to your first appointment.
We require a credit card to be placed on file. To do this in the patient portal: On the left-hand side of the portal, there is a toolbar. There, you will see a button that looks like a credit card or says "billing/financials" -- that is where you will insert your card information. The system requires that, in order for your card to save on file, you are charged a one-time one-dollar fee; please charge yourself this $1.00 so that the card will be saved on file for you. This will be a credit to your account, applied towards any future appointment costs.
To avoid missing communciation from our office, please save our office phone number in your phone: 412-467-6410 and whitelist our emails: admin@balancepsych.org & billing@balancepsych.org
Welcome to our practice! Please reach out to us at any time with questions or concerns. Hit submit below after using the patient portal link.
Click here for patient portal

Upload Your Insurance Card Here

Click or drag a file to this area to upload.

When scheduling your appointment, you may select any of the following providers for psychiatric care:

Theresa Webster, PMHNP

Davonna Wilson, PMHNP

Kathryn Molczan, PMHNP

Shelby Dobrich, PMHNP

Jennifer Taylor, PMHNP

Jennifer Foresman, PMHNP

When scheduling your appointment, you may select any of the following providers for psychiatric care:

Theresa Webster, PMHNP

Davonna Wilson, PMHNP

Kathryn Molczan, PMHNP

Jennifer Taylor, PMHNP

Jennifer Foresman, PMHNP

When scheduling your appointment, you may select any of the following providers for psychiatric care:

Theresa Webster, PMHNP

Davonna Wilson, PMHNP

Kathryn Molczan, PMHNP

Jennifer Taylor, PMHNP

Jennifer Foresman, PMHNP

When scheduling your appointment, you may select any of the following providers for psychiatric care:

Davonna Wilson, PMHNP

Kathryn Molczan, PMHNP

Shelby Dobrich, PMHNP

Jennifer Foresman, PMHNP

When scheduling your appointment, you may select any of the following providers for psychiatric care:

Kathryn Molczan, PMHNP

Davonna Wilson, PMHNP

When scheduling your appointment, you may select any of the following providers for psychiatric care:

Theresa Webster, PMHNP

Davonna Wilson, PMHNP

When scheduling your appointment, you may select any of the following providers for psychiatric care:

Theresa Webster, PMHNP

Kathryn Molczan, PMHNP

Your psychiatric provider will be Alicia Berger. Alicia is a Psychiatric Nurse Practitioner. Please be sure to select Alicia Berger when requesting your appointment.

Your psychiatric provider will be Jennifer Taylor. Jennifer is a dual certified Psychiatric Nurse Practitioner and Family Nurse Practioner. Please be sure to select Jennifer Taylor when requesting your appointment.

Your psychiatric provider will be Theresa Webster. Theresa is a Psychiatric Nurse Practitioner. Please be sure to select Theresa Webster when requesting your appointment.

When scheduling your appointment, you may select any of the following providers for psychiatric care:

Davonna Wilson, PMHNP

Jennifer Foresman, PMHNP

Your physical health provider will be Douglas Ludington. Douglas is Family Nurse Practioner. Please be sure to select Douglas Ludington when requesting your appointment.

Your psychiatric provider will be Kathryn Molczan. Kathryn is a Psychiatric Nurse Practitioner. Please be sure to select Kathryn Molczan when requesting your appointment.

When scheduling your appointment, you may select any of the following providers for psychiatric care:

Kathryn Molczan, PMHNP

Jennifer Foresman, PMHNP

Your psychiatric provider will be Davonna. Davonna is a dual certified Psychiatric Nurse Practitioner and Family Nurse Practioner. Please be sure to select Davonna Wilson when requesting your appointment.

Your psychiatric provider will be Jennifer Foresman. Jennifer is a Psychiatric Nurse Practitioner. Please be sure to select Jennifer Foresman when requesting your appointment.

Your psychiatric provider will be Alicia Berger. Alicia is a Psychiatric Nurse Practitioner. Please be sure to select Alicia Berger when requesting your appointment.

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New Patients

We are not currently able to prescribe controlled medications in this state.

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