This form is for NEW Prospect Clients & *Returning Clients to request an Intake Appointment as well as to request an Insurance Verification / Benefits Quote to make scheduling easy and effortless! This pertinent form allows us to gather basic information to determine reasons for seeking treatment to determine Client-Clinician Match; to provide you with a Benefits Quote, and to schedule your Intake Appointment based on your noted availability. 

What Happens Next? 

Upon receipt of your Appointment Request Form, we will promptly review your submission. If an appropriate client-clinician match, we will subsequently provide you with a Welcome Message. 

The Welcome Message will contain the following: 

  • Intake Appointment Day/Time 
  • Benefits Quote 
  • Intake Forms 
  • Virtual Waiting Room Link

Simply reply "C" to Confirm Intake Appointment.  

Yes, scheduling is really that simple! 

Thank you, 

Melissa E. Mendoza, LMSW

The Pink Positive Psychology Team

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*Returning Clients are past clients that have not been seen in 2-months.  

*If prospect client is not a match we will provide referrals. 

*All Forms are Mobile Friendly / Electronic Forms that are HIPPA compliant and ENCRYPTED which means your information is safe and secure.