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J. Kirk Hartman, MD


(925) 430-2554

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(925) 430-2554

Forms

New Patient Inquiry

Before you schedule an appointment, please fill out the New Patient Inquiry Form.
This short form helps us understand your needs.


If You Have an Appointment for an Initial Evaluation


Please fill out these forms at least one day before your visit. This gives your clinician time to review your information.

  • External link opens in new tab or windowPatient Intake Paperwork
  • External link opens in new tab or windowAdult Intake Rating Scale (for ages 18 and older)
  • External link opens in new tab or windowMinor Intake Rating Scale (for ages 5 to 17)
If You Want Us to Share or Receive Information

In order for our office to coordinate with other clinicians, therapists, family members, etc. we would need you to complete the following form:’

·         Consent Form

·         Record Request

Additional Assessments

Mindset Psychiatry

1600 South Main Street, Suite 180

Walnut Creek, CA   94596

P:  (925) 430-2554

F:  (925) 217-4476


Office Hours:  8:30 am - 5:00 pm

                          Mon - Thu


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Mindset Psychiatry

1600 South Main Street, Suite 180

Walnut Creek, CA   94596

(925) 430-2554


Copyright © 2022  Mindset Psychiatry

Site by External link opens in new tab or windowAlamoWeb Solutions

Copyright © 2022  Mindset Psychiatry

Site by External link opens in new tab or windowAlamoWeb Solutions

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