Schedule a Consultation

Take the first step toward care that sees you as a whole person. Complete the form below and we'll be in touch within one business day to schedule your initial consultation.

Submit Request

Complete the brief intake form below. No sensitive health information needed at this stage.

We Connect

We'll reach out within one business day to discuss your needs and schedule your first appointment.

Initial Consultation

A 60-minute comprehensive evaluation, in person or via telehealth. No rushed visits.

Consultation Request

Fields marked with * are required. This form is for scheduling purposes only.

First Name *

Last Name *

Email *

Phone *

Date of Birth (for age verification only — not stored as PHI)

State of Residence *

Telehealth availability depends on state licensing.

Preferred Visit Type

How Did You Hear About Us?

What brings you to Azimuth?

Insurance (if applicable)

Azimuth operates as a concierge practice. We can discuss insurance, superbills, and out-of-network benefits during your consultation.

I understand this is not a secure or HIPAA-compliant communication channel. I will not include protected health information in this form. I consent to being contacted at the email and phone number provided. *

Your information is used only to schedule your consultation. See our Privacy Policy. For clinical matters, secure communication will be established once you become a patient.

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Request Received

Thank you for reaching out. We'll contact you within one business day to schedule your initial consultation. If you need immediate assistance, please call (203) 718-6513.

Phone

(203) 718-6513

Location

267 Grant Street, Greater New Haven Area, CT 06610

Hours

Mon-Fri 9 AM - 5 PM EST

Telehealth

Available Nationwide