Select all that apply — this helps us match you with the right specialist.
You can select more than one
Type of care
What brings you in today?
This helps us match you with the right provider and booking experience.
Urgency
How long have you been experiencing this?
This helps us understand how quickly we need to connect you with a provider.
Your location
Which state are you located in?
We'll use this to confirm provider licensing and availability in your area.
Appointment preference
How would you like to meet with your provider?
Both options are available with most insurance plans.
Almost done
How should we reach you?
A care coordinator will call you within a few hours to confirm your match and
schedule your appointment.
Please enter your first name.
Please enter your last name.
Please enter a valid phone number.
Please enter a valid email address.
By submitting, you agree
to be contacted by a SameDayPsych care coordinator. Your information is private and HIPAA-protected. Consent to receive text messages is not a condition of service — you can uncheck the box above and still book a session.
Insurance & identity
Let's verify your coverage
This helps us confirm your benefits before your appointment so there are no
surprises. All information is encrypted and HIPAA-protected.
Insurance information
Please select your insurance provider.
Please enter your member ID.
Identity verification
Required for prescribing
providers and insurance billing. Your ID is stored with 256-bit encryption and never shared.
Please select your ID type.
Please enter your ID number.
Please enter your date of birth.
Payment method
A card on
file is required for all patients. If your insurance claim is denied
or results in a patient balance, your card on file will be charged for the remaining amount. You
will be notified before any charge.
Card on file
256-bit SSL encrypted
Billing authorization & card-on-file agreement: By providing your payment
method, you authorize SameDayPsych to charge your card for any patient balance remaining after
insurance processing, including but not limited to: deductibles, co-insurance, co-pays, and any
services denied by your insurance plan. SameDayPsych is currently an
out-of-network provider. Your plan may cover a portion of services as an out-of-network benefit.
You will receive an Explanation of Benefits (EOB) from your insurer and an itemized statement
before any balance is charged. You may contact us to dispute any charge within 30 days of billing.
Important — Medicaid patients: Federal and state law prohibits balance billing for
Medicaid-covered services. Your card on file will only be used for services not covered under your
Medicaid plan, or if your eligibility cannot be verified at the time of service. A care coordinator
will confirm your coverage before your appointment.
Your data is secure. All information is transmitted over
SSL, stored with AES-256 encryption, and handled in full compliance with HIPAA and PCI-DSS. We never
sell or share your personal data.
By submitting, you agree to continue to your consent forms on the next page. SameDayPsych will not charge your card without an itemized statement.
Submitted successfully
Thanks you — one moment
We're taking you to booking now. A care coordinator will also call within a few hours.
Your information
Care needs
Insurance & billing
Agreements signed
What happens next
1Our care coordinator reviews your
submission and identifies the best-matched licensed provider in .
2They call you to confirm your
appointment, verify insurance, and answer any questions.
3Your appointment is booked — often
same day. You'll receive a confirmation with all details.
If you're experiencing a mental health emergency, we want to help you get the right care right now.
SameDayPsych is not an emergency service. If you're in immediate danger, please call 911 or reach the 988 Suicide & Crisis Lifeline.