Request and Intake Packet

Request an intake form

Please submit this form only after reviewing the fit check. Dr. Goldman personally reviews each request and will respond if the practice may be a good match. You can expect to receive a set of intake forms within two business days.

Name
Are you located in Arizona or Colorado?
Does tele-psychiatry work for you?
Are you good with private pay?
($600 for the initial session / $375 for a standard 50-minute session / $300 for a abbreviated 25-minute session)
Which of the following do you resonate with?