New Patient Information

If you are interested in becoming a patient at Betts Psychiatric, please look over our process for new patients interested in our psychiatry Eugene services. Feel free to contact us if you have any questions. We’re happy to help! We are now accepting patients for our waiting list.

How To Book An Appointment

Fill out our information form below. If assistance is needed, call our office at 541-505-8621. During this process, we will ask for contact and insurance information, the reason for seeking services, and other information to determine if our providers will be able to help you. We will need time to verify and review your information. Our goal is to contact you within two weeks to let you know if we can schedule you. In some cases, we may ask you to provide records from previous providers. If we are not able to accommodate your needs, we will attempt to inform you of other options.

After the information review process is complete, you will be contacted to schedule a 90-minute intake appointment. Please note: if you are not able to attend, you must give 24-48 hours notice in order to be rescheduled. We are not able to reschedule patients who do not attend their first appointment and do not follow our cancellation policy.

Please bring your photo ID and insurance card, along with a list of any prescriptions you are taking to your appointment. We will also send you patient forms to complete electronically and then sign securely through DocuSign.

Thank you for your interest in Betts Psychiatric, PC. We look forward to meeting you and helping you reach your recovery goals.

Information Form

Name *

First

Middle

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Best Time to Call

Morning
Afternoon
Evening

Email *

Services Seeking

Medication
Therapy
Both

Date of Birth *//

Insurance *

Ins. ID Number *

Ins. Group Number *

Secondary Insurance

Secondary Ins. ID Number

Secondary Ins. Group Number

Complaints

ADHD
Anxiety
Bipolar Disorder
Depression
Eating Disorder
Insomnia
Obsessive/Compulsive Disorder
Post Traumatic Stress Disorder
Other

If Other, Please Explain

Sex at Birth *

Male
Female
Other

Marital Status *

Married
Single
Divorced
Separated
Widowed
Partnered

Occupation

Referred By

Primary Care Provider

Previous Psychiatric Provider

Have you previously been seen by any of the providers at Betts Psychiatric?

If Yes, Who?

Current Medications

Disability Claim?

Pregnant?

Breastfeeding?

Other Comments

Captcha *

Message

How To Book An Appointment

Fill out our information form below. If assistance is needed, call our office at 541-505-8621. During this process, we will ask for contact and insurance information, the reason for seeking services, and other information to determine if our providers will be able to help you. We will need time to verify and review your information. Our goal is to contact you within one week to let you know if we can schedule you. In some cases, we may ask you to provide records from previous providers. If we are not able to accommodate your needs, we will attempt to inform you of other options.

After the information review process is complete, you will be contacted to schedule a 90-minute intake appointment. Please note: if you are not able to attend, you must give 24-48 hours notice in order to be rescheduled. We are not able to reschedule patients who do not attend their first appointment and do not follow our cancellation policy. Please bring your photo ID and insurance card, along with a list of any prescriptions you are taking to your appointment. You will also need to download, print and complete these forms and bring them in with you. Thank you for your interest in Betts Psychiatric, PC. We look forward to meeting you and helping you reach your recovery goals.

Information Form

Name *

First

Middle

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Best Time to Call

Morning
Afternoon
Evening

Email *

Services Seeking

Medication
Therapy
Both

Date of Birth *//

Insurance *

Ins. ID Number *

Ins. Group Number *

Secondary Insurance

Secondary Ins. ID Number

Secondary Ins. Group Number

Complaints

ADHD
Anxiety
Bipolar Disorder
Depression
Eating Disorder
Insomnia
Obsessive/Compulsive Disorder
Post Traumatic Stress Disorder
Other

If Other, Please Explain

Sex at Birth *

Male
Female
Other

Marital Status *

Married
Single
Divorced
Separated
Widowed
Partnered

Occupation

Referred By

Primary Care Provider

Previous Psychiatric Provider

Have you previously been seen by any of the providers at Betts Psychiatric?

If Yes, Who?

Current Medications

Disability Claim?

Pregnant?

Breastfeeding?

Other Comments

Captcha *

Name

Contact



725 Country Club Rd.
Eugene, Oregon 97401



541-505-8621



541-654-5063

Hours

Monday - Thursday, 8:00am - 5:00pm
Friday - Sunday, CLOSED

Office closed on all federal holidays.

Quick Links

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