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Sutton Psychiatry & Behavioral Health

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Reason for care

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1 Appointment info

2 Prescreener

Reason for care

3 Contact information

What is the reason for seeking care?

Anxiety Panic attacks Depression Mood swings/Emotional dysregulation Bipolar disorder PTSD/Trauma OCD Insomnia/Sleep problems Attentional difficulties ADHD evaluation Psychosis Substance use Grief Medication management Other

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

Are you currently experiencing thoughts of suicide or self-harm?

If you are in immediate danger or unable to keep yourself safe, call 911 or 988, or go to the nearest emergency department. This form is not monitored continuously.

Are you seeking evaluation or treatment for ADHD?

Yes No Not sure

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

Sutton Psychiatry & Behavioral Health

570.410.9750 |

Pennsylvania

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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.