ClearMind — Patient Portal

Good morning

Here's a summary of your care

Next Appointment

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No upcoming appointments

Active Medications

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Current prescriptions

Unread Messages

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From your care team

Pending Forms

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Consents & questionnaires

Recent Messages

Appointments

Your upcoming and past sessions

Upcoming

Past Appointments

Visit Summaries

Summaries from your care team after each visit

Medications

Your current prescriptions

Active Medications

Discontinued / Past

Messages

Communicate with your care team

Inbox

💬

Select a message to read

Consents

Review and sign your consent forms

Pending Signature

Signed

Questionnaires

Help your care team track how you're doing

PHQ-9 — Depression Screening

Over the last 2 weeks, how often have you been bothered by the following?

Not yet completed

GAD-7 — Anxiety Screening

Over the last 2 weeks, how often have you been bothered by the following?

Not yet completed

Past Results

Intake Forms

Please complete before your first appointment

Personal & Contact Information

First Name

Last Name

Date of Birth

Gender

Phone

Email

Address

Emergency Contact

Name

Relationship

Phone

Presenting Concerns

What brings you to seek services? (Please describe in your own words)

Have you received mental health treatment before?

Are you currently taking any medications?

List any current medications and dosages

Safety

Do you have any current thoughts of harming yourself or others?

Additional safety concerns or context

Insurance

View and update your insurance information

Primary Insurance

Insurance Provider

Plan Name (if known)

Member ID / Medicaid ID

Group Number

Subscriber Name (if different from you)

Subscriber Date of Birth

Relationship to Subscriber

Secondary Insurance (optional)

Provider

Member ID