New Patients

Get a Head Start on Your Future Visit

paperworkIf you want to make an appointment with one of the many behavioral health professionals at St. Louis Behavioral Medicine Institute, please use the forms below to get a head start on the information you’ll need to provide.

If you are an existing patient utilizing our Telehealth option for the first time, please review and sign our Converting to Telehealth Form.

Request an Appointment

This form may not be completed by minors (under 18 years old). If the patient is under age 18, a parent or legal guardian may complete the form for their minor children.

Adults (over 18 years old) may not complete the form for any other adults, unless the completer of the form has power of attorney or legal medical guardianship for the adult.

After you submit this form, the SLBMI Intake Department will contact you within 24 business hours. To respect your privacy, the Intake Department will try to reach you no more than two times without response. When you speak with our intake specialists, please make sure you have information about your current and/or past treatment and medication experiences.

We accept most major insurance companies, but we do not accept Medicaid Primary and Ambetter.

If at any time you feel you need immediate and critical assistance, please present yourself to the nearest Emergency Department, call the Crisis Hotline (Behavioral Health Response: 314-469-6644 or Provident St. Louis 24-hour Crisis Line: 314-647-4357) or call 911. Please do not wait for a return call from the intake specialists if you are in need of immediate and critical assistance.

Please note that all fields marked with an asterisk (*) are required.

  • MM slash DD slash YYYY

Pre-Visit Patient Registration Forms

After you’ve received confirmation of your scheduled appointment, we encourage you to print and fill out our New Patient Registration Form and bring it with you for your first appointment. Based on which psychiatrist you are assigned to, you will also need to fill out a registration form for that specific psychiatrist. If you do not have a printer at home, you may also fill out the forms at one of our offices on your first visit.

Additional Forms

We’re Only a Phone Call Away

Our Intake Coordinators are always available at 314-289-9411 to schedule a confidential assessment if you, a loved one, or a patient may be experiencing a mental health issue. For additional questions about our programs, you can also use our online contact form.

In the case of a medical emergency or crisis, please dial 911 or go to the nearest emergency room.

Contact Us

New patients please call Intake Coordinators at:


City of St. Louis, Missouri (Macklind)

1129 Macklind Ave, 
St. Louis, MO 63110 
314-534-0200 (returning patients)

Chesterfield, Missouri (West County)

16216 Baxter Rd. Stes 205 and 225,
Chesterfield, MO 63017
636-532-9188 (returning patients)

Belleville, Illinois

521 W. Main St. Ste 201B, 
Belleville, IL 62220
618-825-0051 (returning patients)