Spectrum Psychology & Wellness New Patient Pre-Screening Get started by filling out the form below! "*" indicates required fields First Name* First Name Last Name Last Phone*Email* Date of Birth* Is the potential client a minor?*Please SelectYesNoParent Name* Parent First Name Parent Last Name Parent Phone*Parent Email* Brief Reason for Coming In*HiddenPlease Select Provider*Rebbeca Lahann, Psy.DRachel Jensen, Ph.DMonika Peterson, Ph.DLeslie O’Neill, Ph.DBryan Gaviria-Jimenez, Psy.DMercedes Anderson, Ph.DJeff Lahann, MBANo PreferencePlease Select Provider* Rebbeca Lahann, Psy.D Rachel Jensen, Ph.D Monika Peterson, Ph.D Leslie O’Neill, Ph.D Bryan Gaviria-Jimenez, Psy.D Mercedes Anderson, Ph.D Jeff Lahann, MBA No Preference Insurance ID Number/Policy Number* Insurance Provider (e.g. Blue Cross Blue Shield)* It may take some time to get you scheduled with your preferred provider. We are not a crisis care facility. If you feel you are in crisis and need to be seen urgently, please call 911 or 988, or call the EMPACT crisis hotline at 480-784-1500 for assistance. Please note, our office does not provide court ordered, alcohol or substance abuse or medication management services.
