Patient Forms

If you are a new patient and would like to book an appointment, we encourage you to use our online portal.  You can use this convenient resource to check appointment availability, request appointments, and view important documents. The online portal is a convenient way to schedule appointments; however, please contact us by phone (850-329-5776) if you need any assistance. 

To access the online portal, please click here:​

**If you are an agency referring a patient for services, please note that a signed Release of Information must be included with the referral before we can contact or update you on the status of the referral.  Release of Information forms can be found at the bottom of this page. Please feel free to upload (located at the end of the new patient referral form below), fax (888-974-6195), or email (staff@dawnahaswell‐ the completed Release of Information. 

**DISCLAIMER: The online portal and new patient form should NOT be used in crisis/emergency situations (e.g. if you are currently experiencing thoughts of suicide, homicide, or self-harm). If you are experiencing a life threatening emergency please contact 911 or go to your nearest emergency room for immediate assistance. If you or someone you know is feeling suicidal or in an emotional crisis, you can also contact the National Suicide Prevention Lifeline at 1-800-273-TALK.

By clicking 'Submit' you agree that you are the person identified above and as the referring agency, you have obtained the appropriate release of information needed to make this referral.

New Patient ​​Referrals from Outside Agencies

​​New Patients