Helpful Forms

Click below for the New Patient (Fillable) Intake Form:     

https://form.jotform.com/22016…

Or, please please complete the following 3 forms and bring them to your first therapy session.

If you would like our office to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize the release of psychotherapy information:

Please scan this QR Code with your mobile device’s camera to access our Patient Intake form.

QR Code Patient Intake Form

Get More Information

Call

(559)-754-3011

Email

doctor@minddivers.com

Address

1041 N Demaree Street

Visalia, CA 93291

 

Hours

Mon – Fri: 9am – 5pm
Weekends: By Appointment