NEW APPOINTMENT REQUEST FORM

The form below is intended for new patients only. 

Please provide as much information as possible, including a brief overview of past psychiatric treatment. Please also indicate your choices of appointment times. 

If you are looking for an appointment within a specific date range, please indicate it here:

* indicates a required field

601 Main Street, Suite 505

Vancouver, WA 98660

(The Heritage Building)

(360) 773-6340

(360) 326-2606 fax

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©2019 Harmony Mental Health Services of NW