Request appointment | Dr. Albarado

What is the reason for seeking care?

Anxiety Attentional difficulties Behavioral issues Depression Grief Relationship issues Substance use Trauma Other

List all medications you (or the minor prospective client) are presently taking. If none, type "none or N/A."

Please also include medications for non-mental health conditions (such as diabetes, hypertension, etc).

Limited to 600 characters

What mental health concerns or treatment have occurred in the past?

In therapy now In therapy in the past Taking psychiatric medication now Taken psychiatric medication in the past Hospitalized for mental health reasons now or recently Hospitalized for mental health reasons in the past Known neurologic or genetic disorder Attempted suicide in the past None of these apply

Please indicate if you (or the minor prospective client) have been prescribed any of these medications before

Antidepressants (Prozac, Paxil, Zoloft, Luvox, Trintellix, Viibryd, Cymbalta, Effexor, Pristiq) Other antidepressants (Wellbutrin, Elavil, etc) Stimulants (Adderall, Vyvanse, Ritalin, Concerta, Focalin, etc) Sedatives (Klonopin, Xanax, Ativan, etc) Other sedatives (Ambien, Lunesta, or similar) Mood stabilizing medications (Abilify, Vraylar, Seroquel, Risperdal, Latuda, etc) Other mood stabilizing medications (Lamictal, tegretol, Topamax, Depakote, Lithium, etc) Other psychiatric medications NONE tried in the past

Are you (or the minor prospective client) involved in any legal matters, including custody disputes, lawsuits, or worker's compensation claims?

What is your (or the minor prospective client's) current occupation? If a student, please provide the school and grade level.

Any alcohol or substance use? Please describe type and frequency.

Do you (or the prospective minor client) have any physical or medical problems? Please include neurological, cardiac, autoimmune, etc. If not, type "none or N/A."

Examples: high blood pressure, concussion, seizures, diabetes, asthma, reflux.

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