Steel City CBT, PLLC Send Message

Who would be receiving care?

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Reason for care
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Note: A psychiatrist is a medical doctor who prescribes and manages psychiatric medications (e.g., anti-depressants, anxiety or sleep medications).
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Administrative
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Billing & Payment
How do you plan to pay for services?
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PLEASE NOTE: THIS QUESTION IS FOR INFORMATIONAL AND FUTURE BUSINESS PLANNING PURPOSES ONLY
Client Preferences
For example: what you'd like to focus on, insurance or payment questions, etc.
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By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.