Request appointment | Arzilence Psychiatry

What is the reason for seeking care?

Re-establishing care ADHD / attention / executive function Anxiety / panic Depression / low mood Mood instability OCD / intrusive thoughts / compulsions Trauma-related issues Sleep problems Grief/ Loss Substance use concerns* Relationship stress affecting mood/anxiety Other**

What kind of care is being sought?

Psychotherapy Medication Management Combination (psychotherapy and medication management) Not sure/ Seeking professional consultation Transcranial magnetic stimulation (TMS) - Available starting Spring 2026 Interested in learning about the Adult ADHD Program

What mental health concerns or treatment have occurred in the past?

*If you selected Substance use concerns, please include: Substance(s); Typical frequency/amount; Last use; Any withdrawal risk (history of withdrawal seizures/DTs); What you’re hoping for (cut down, stop, cravings meds, evaluation).

Eg. "Alcohol: 4–6 drinks nightly; last use yesterday; no withdrawal seizures; want help reducing/cravings.”

** If you selected Other, please describe

I understand that Arzilence Psychiatry is not able to provide crisis services or urgent safety management. If I have immediate safety concerns, I will call 911, go to the nearest emergency department, or call/text 988 for immediate support.

I understand

I understand that if I have had inpatient hospitalization or a partial hospitalization/intensive outpatient program within the past 3 years, I may be asked to provide records from that treatment before care can be established at Arzilence Psychiatry.

I understand

I understand that Arzilence Psychiatry does not provide treatment for primary substance use disorders. Substance use questions in this prescreener are used to assess how substance use may be impacting other mental health concerns that may be appropriate for care here.

I understand

I understand that establishing care at Arzilence Psychiatry does not imply agreement to continue my current medication regimen, including prescribed controlled substances (e.g., benzodiazepines or stimulant medications). If changes are recommended, they will be discussed collaboratively and planned with attention to safety and avoiding abrupt discontinuation when clinically appropriate.

I understand

I understand that Arzilence Psychiatry does not provide treatment for primary eating disorders, and that any questions about eating concerns are used to understand how they may be affecting other mental health concerns that may be appropriate for care here.

I understand

I understand that Arzilence Psychiatry provides outpatient psychiatric care and is not able to establish care for any patient who is currently residing in a residential treatment program or group home.

I understand

I have read and understand that submitting this form does not establish a treatment relationship and is not a way to reach help in an emergency.

Before you submit — please read Submitting this form does not establish a physician–patient or treatment relationship with Arzilence Psychiatry, P.C. or any of its clinicians. A treatment relationship begins only after a completed intake evaluation and our mutual agreement to begin care. This form is intended for non-urgent inquiries and is not monitored continuously. If you are experiencing a psychiatric emergency or have immediate concerns about your safety or someone else's, do not wait for a reply: - Call 911 or go to your nearest emergency department. - Call or text 988 — the Suicide & Crisis Lifeline, available 24/7. - In Rhode Island: BH Link, (401) 414-LINK (5465), or walk in 24/7 at 975 Waterman Ave., East Providence (adults 18 and older). - Butler Hospital's 24/7 behavioral health line: (844) 401-0111.

I understand

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