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WEB New Patient Inquiry - v2

Page One

Hello, my name is Peter Forster and I am the clinic director for Gateway.
Hello, my name is Peter Forster and I am the clinic director for Gateway.
The completed form will be emailed to a clinician at Gateway. As with all electronic communications, email is inherently insecure. If you want to guarantee the security of your message, please install a secure email service, like Virtru, and email our office manager directly at hershe@gatewaypsychiatric.com.
Please fill out the form below and we will be in touch shortly.
Have you reviewed the information on our website about our clinic and the page entitled "beginning a consultation"?
How do you prefer to be contacted?