Please complete the following form.

Upon completion, you will be able to

select a time to meet for your free

15-minute intro appointment.

First name

Last name

Email

For which of the following

are you seeking treatment?

*Only available with Proactive Complete℠

In which of the following

treatment options are

you interested?

Proactive Complete℠

Proactive Express℠

Proactive Longevity℠

If you have not reviewed the treatment options, please review Options & Pricing.

"I have read The Proactive Approach℠

My Promise, and Options & Pricing.

I know you do not accept insurance.”

Yes, I have read the required pages!

If you have not read these pages and polices,

please do so before continuing.

"I am committed to change.

I understand change is uncomfortable

and the results I will see are related

to my efforts."

Yes, I am committed to change!

If you cannot make this commitment,

we are not a good fit at this time.

"I am ready to invest in myself,

including with my time and financially,

in order to reach my goals

and optimize my life."

Yes, I am ready!

If you are not ready for this investment,

we are not a good fit at this time.

"I understand this request does

not establish a provider-patient

relationship and is not a treatment

session. With my 15 minutes I will

ask questions about the practice,

about Ryan, and share my goals.

I will not ask for medication or

medical advice."

Yes, I understand!

"I am not seeking emergency care.

Proactive Psychiatry does not provide emergency care for suicidal or homicidal ideation, mania, hypomania, catatonia,

or any emergent condition."