Request An Appointment

The first appointment, or intake, will last 75-minutes and will be used to get a detailed history and description of your problem. If you are ready to request an appointment, please use the form below to submit some basic information which will help to streamline the process. You will receive a confirmation phone call or email in 2-4 business days of your request to finalize a date and time and to be given some additional instructions and forms. Please note that, due to COVID-19 office closures, all meetings are being held via telehealth and not in person.

Information

Fill in this information and submit to make an initial appointment request:

Name

First Name

Last Name

Email Address

House/Apt # and Street

City/Town

State

Zip Code

Home Phone

Mobile Phone

Work Phone

Do you have Medicare?

Yes

(For Medicare members, only) Do you have a secondary private insurer that participates in a Medicare crossover?

Yes

Briefly mention why you are seeking my services.

Forms

Download, fill out and sign the following forms after you have scheduled your initial appointment:

Patient Intake Form

Notice of Privacy Practices

Informed Consent

For Medicare Members only: Medicare Agreement

Valerie L. Gaus, Ph.D., ABPP

Valerie L. Gaus, Ph.D., ABPP

Appointment

Valerie L. Gaus, Ph.D., ABPP

Request An Appointment

Information

Forms

Valerie L. Gaus, Ph.D., ABPP