Ready to schedule an appointment?

Ready to take that next step? If you answer is "I AM" then you have come to the right place!

Our staff is standing by to answer any questions you may have. A referral from your primary care physician, therapist, or other health care provider maybe be required depending on insurance but not always necessary.

Need To Do A Self-Referral? No Problem! IAM IS READY!

Patient First Name

Patient Address

Phone (used for callbacks & texts)

Patient Last Name

City, State & Zip Code

Date of Birth (00/00/0000)

Guardian Name (if minor patient)

Email (used for patient app)

Insurance Information or Self-Pay (If you are using insurance- We need the Company Name, Member # or ID, Group #, Subscriber Name & Date of Birth)

List of current medicaions with daily dosage (If you believe the medication is not working then add details please)

Preferred Location: * Required

First Available - ANY OFFICE: Dr. Dhaliwal

HUNTSVILLE - 185 Whitesport Drive SW, Suite 5: Lauren Ross, CRNP, Ashley Sykes, CRNP, and Jacob Quinn, ALC

MADISON - 11745 County Line Road, Suite C: Stephanie Blume, CRNP, Erin Russell, LMFT, and Jacob Quinn, ALC

Is there a prefered provider you would like to see?

Here for Testing/Therapy? * Required

ADHD

Autism Testing (Child or Adult)

Medication Management

MOOD Evaluation

Talk Therapy with Erin Russell

PRT Therapy with Erin Russell

Talk Therapy with Jacob Quinn

TMS Therapy

What brings you to IAM? (The more details the better we can assist you faster)

Thanks for submitting! Please allow 48 hours for us to answer your referral.

Institute of Attention & Mood

Phone: 256-880-3500

Fax: 256-880-9203

HUNTSVILLE LOCATION:

185 Whitesport Dr SW Suite 5

Huntsville, AL 35801

MADISON LOCATION:

11743 County Line Road Suite C

Madison, AL 35758

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