Psychological Services Request

Seeking psychological services for you and your child and not sure who to contact?

With one inquiry your request can be reviewed by over 20 experienced psychologists whose skills cover a wide range of specialties. There is no obligation, no charge, and all information is treated confidentially.*

Instructions:
1. Provide as much information as you are comfortable giving, then click "Submit."
2. If a psychologist on our list is available to help you will receive a call or e-mail response

I am...
Surname, First Name

Best ways to Contact:

Day Phone:

Evening Phone:

Cell Phone:

Other(E-mail):

I need services for...

, please list

If seeking services for child(ren)...

Number of children:

Grade(s): and Age(s):

Referred by:

 

Tip: Select more than one by holding CTRL key

Briefly describe the problem or issue:

Are specific services required?

Psychotherapy, Individual or Group Parent/Family

Consultation with School or Doctor

Is psychological or psycho-educational testing needed?

Type(s):

Tip: Use CTRL to select more than one

Where would you prefer to be seen: (e.g. Cary, Apex, N. Raleigh)


Holly Springs
Other Locale:

Appointment time and/or day preferred:

Insurance Provider or Mental Health Benefit Manager:
Is there anything else you'd like to tell or ask us?

Please note that if your need for services is urgent or an emergency you should call a professional such as your child’s pediatrician, go to an emergency room, use the Holly Hill Hospital Respond program, or call 911.

Generate another code

 

  • You may receive multiple responses, or, if no one is available, no response.
  • Doctor-Patient relationship requires signed Psychologist-Client Services Contract
  • Participating members of the Triangle Psychology list are independent practitioners.
  • Our list of providers does not include tutors or speech therapists


 


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Triangle Psychology is provided as a service to the local provider group, which is responsible for all content, response to inquiries, and services offered.