Start with guided intake for psychiatric care

This page is for adults who want SacredHLI to review their situation and guide them to the right next step for PMHNP-led telepsychiatry.

This page is for you if:

• You are not fully sure which psychiatric service is right for you
• You want SacredHLI to review your needs before directing you forward
• You have questions or want a calmer starting point before payment
• You want a structured and supportive intake process

Before you continue

Please continue only if the following apply to you:

• You are 18 years or older
• You are located in California, Texas, Arizona, or Colorado
• You are seeking psychiatric care or medication support, not therapy-only services
• You are not in immediate crisis or danger

If you are in immediate danger or crisis, call 911 or 988 now.

What happens next

Submit your guided intake request

Complete the form below and SacredHLI will review your request and guide you to the right next step.

Please enable JavaScript in your browser to complete this form.

Section 1: Identity & Logistics

Name *

First

Last

Email *

Email

Confirm Email

Phone *

Date of Birth *

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State you will physically be located in during appointment *--- Select Choice ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Referred by?

Section 2: Visit Type

Required Dropdown *--- Select Choice ---Initial Psychiatric EvaluationMedication Managment Follow-UpOut-of-Network (Superbill Requested)Private Pay (No Superbill)

Section 3: Current Clinical Stability

1) Are you currently experiencing thoughts of harming yourself? *--- Select Choice ---YesNo

2) Are you currently experiencing thoughts of harming others? *--- Select Choice ---YesNo

3) Are you currently experiencing hallucinations, severe paranoia, or loss of touch with reality? *--- Select Choice ---YesNo

4) Have you been hospitalized for psychiatric reasons within the past 30 days? *--- Select Choice ---YesNo

5) Are you currently detoxing from alcohol, benzodiazepines, or opiods? *--- Select Choice ---YesNo

IMPORTANT NOTICE

Based on your responses, you may require a higher level of care than SacredHLI provides via outpatient telehealth.

If you are in immediate distress, call 911 or 988.

Section 4: Functional Stability

6) Are you currently able to: Maintain daily responsibilities (work/school/home) *--- Select Choice ---YesNo

currently telehealth of

7) Are you currently in therapy or under care of another psychiatric provider? *--- Select Choice ---YesNo

8) Primary reason for visit (choose one) *--- Select Choice ---AnxietyDepressionADHDSleep issuesMood instability (not manic crisis)Medication refill /managementOther (short text)

Section 5: Substance Use Stability

9a) Do you currently use: Alcohol socially only? *--- Select Choice ---YesNo

9b) Do you currently use: Marijuana ocassionally? *--- Select Choice ---YesNo

9c) Do you currently use: Prescription medication as directed? *--- Select Choice ---YesNo

9d) Do you currently use: Heavy daily substance use? *--- Select Choice ---YesNo

9e) Do you currently use: None? *--- Select Choice ---YesNo

NP REVIEW REQUIRED
Heavy daily substance use reported.

Section 6: Telehealth & Scope Acknowledgement

I understand this is outpatient telehealth care. *--- Select Choice ---Yes

I am not currently in crisis. *--- Select Choice ---Yes

I understand SacredHLI does not provide emergency services *--- Select Choice ---Yes

I consent to telehealth evaluation. *--- Select Choice ---Yes

Submit