Request appointment | Carolina Women's Psychiatry, PLLC

Carolina Women's Psychiatry, PLLC

Request an appointment

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Reason for care

Select date & time

1 Appointment info

2 Prescreener

Reason for care

3 Contact information

In your own words please tell me the reason for seeking care today. Be as detailed as possible.

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What kind of care is being sought?

Psychotherapy Medication Other Not sure

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 list all medications you are currently taking and dosage:

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Please list all psychiatric medications you have tried in the past and your response to them:

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Please list your current medical providers:

Primary Care Doctor/ OBGYN

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Please list any relevant medical problems or surgeries:

EX: high blood pressure, diabetes

Are you currently pregnant or trying to become pregnant?

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For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

Carolina Women's Psychiatry, PLLC

910.601.9917 |

North Carolina

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THE CLIENT PORTAL IS NOT TO BE USED FOR EMERGENCY SITUATIONS. IF YOU OR OTHERS ARE IN IMMEDIATE DANGER OR EXPERIENCING A MEDICAL EMERGENCY, CALL 911 IMMEDIATELY.