Our Clinicians
Patient Center
Services
Careers
Contact

Beech Tree Consulting & Psychological Services

Our Clinicians
Patient Center
Services
Careers
Contact

Appointment Request

COVID-19 Update: Our clinicians are currently offering both in-office and telehealth appointments.

If you would like to request an appointment at Beech Tree, please complete and submit the form, below.

Name of person to be seen *

First

Last

Name (if parent/guardian)

First

Last

Date of birth of person to be seen *

Email *

Phone *

Reason for appointment *

I would like to receive services *

In the office
By telehealth

Telehealth refers to services delivered by HIPPA-compliant video chat.

Requested Service *

Therapy
Assessment
Both
Unsure

Do you have a specific clinician you wish to see? *

If your requested clinician does not have availability would you prefer

To be placed on a waitlist
To be referred to another clinician

When would you be available for appointments?

Will you be using commercial health insurance to pay for services? *

Yes
No

Please note HSPP providers are In-Network with Anthem/BCBS and can bill Out-of-Network for most other plans. Select providers will soon be in-network with Medicaid. Visit our Patient Center for more information.

Name of Health Insurance Carrier *

How did you learn about us?

Physician/Professional Referral
Personal Referral
Google
Psychology Today
Other

Phone

Fax

317 780 5755

Mail

6411 South East Street, Suite A
Indianapolis, Indiana 46227

Need directions?

Phone

317 780 5750

If You're in Crisis

If you feel you’re in crisis, call the crisis line or visit the nearest emergency room. The crisis line is available 24 hours a day, 7 days a week. If you are in crisis, please seek help immediately.

Local Crisis Line 317 251 7575

National Crisis Line 1 800 273 8255

Text HOME to 741741

Home
Our Clinicians
Patient Center
Services
Contact

6411 South East Street, Suite A
Indianapolis, Indiana 46227

317 780 5750 phone
317 780 5755 fax

IN CRISIS?

Local Crisis Line 317 251 7575
National Crisis Line 1 800 273 8255
Text HOME to 741741

© 2020 Beech Tree Consulting & Psychological Services All Rights Reserved.

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