Referrals are required before you can be scheduled.

Option 1: Have a provider or counselor current or past, fax our office (866-581-8172).

Option 2: Email Dr. Topol a self-referral.

Referrals should include:

  • past treatment information

  • current or past medications

  • mental health diagnoses you may have received in the past

  • reasons for your interest in beginning treatment with Dr. Topol

When you arrive for your first appointment, please fill out and bring the 7 forms listed below
along with copies of the front and back of any of your insurance

  1. Initial Intake

  2. New Patient Information

  3. Consent for Treatment

  4. Health History

  5. Patient Rights

  6. Release of Information

  7. Billing Policy

Release form for current or past patients to allow Dr. Topol to release notes.