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New Patient/Resource Request Form

New Patient Screen/Resource Request Form

Thank you for your interest in services with the Kansas City Center for Anxiety Treatment, P.A. (KCCAT)!

This secure form helps us get a brief history of symptoms and treatment efforts to-date so that we can best guide you on what resources and options may be most appropriate.

If you have not already done so, please review our website for an overview on disorders we commonly treat, frequently asked questions about CBT/ERP, and our policies and fees (including important information regarding insurance). If you prefer, you may call and leave a message at (913) 649-8820, option 1, and a member of our intake coordinator staff will return your call to complete these screening questions over the phone.

Please make sure you complete the entire form; if you do not reach the confirmation page, we have not ​received your information! An intake coordinator will reach out within 1-2 business days if we need additional information, to provide resource options we believe may be helpful to you, and to provide a point of contact before a team member reaches out to schedule.

This form should take about 10-15 minutes.

CBT for Anxiety Group Screening
Thank you for your interest in the CBT for Anxiety Group, an 8-week, evidence-based CBT group, involving education about anxiety, challenging anxious thoughts, facing anxiety-provoking situations, and skills for maintaining success after group.

This group is open to adults age 18 or over. Please complete this form to get started; a member of our team will then reach out to complete next steps.
Please select the age range of the prospective patient: *This question is required.If you are a loved one completing this form for another adult, you must provide the prospective patient’s contact information. You will provide your contact information later in the form. (If you are a loved one looking for services for yourself—for example, a consultation—please list yourself as the patient.)