Text 239.275.3222 for help with one of our keywords: “appointment”, “refill”, “billing”, or “MAT” for Medicated Assisted Treatment

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Patient Forms
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Southwest Florida’s Dedicated Mental Health Provider

As a nonprofit provider of mental and behavioral health services in Southwest Florida, SalusCare is dedicated to your wellbeing.

We ensure everyone receives the support they need, regardless of the cost for those services by accepting most insurance and providing a sliding fee scale for those who qualify for assistance.

Nothing should prevent you or any resident of Southwest Florida from accessing care. At Saluscare, our team of compassionate experts are ready and waiting to serve you!

New Patients

Care Connection

Tell us a little bit about yourself, so we can prepare for your first appointment.

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Forms not available, text us at 239-275-3222

Release of Information

Help your providers share healthcare information for collaborative treatment.

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Auxiliary Aids and Services Plan

Current Patients

Compliment Form

Your compliment means the world to our team – thank you for sharing!

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Feedback Form

Your feedback helps us continuously improve – thank you for sharing!

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Post-discharge Survey

This information will be used to continuously improve patient care.

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Auxiliary Aids and Services Plan

1. Have you been diagnosed with depression or anxiety?
Yes
No

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2. Have you seen a therapist or taken medication for your symptoms?
Yes, I have tried both therapy and medication.
I have tried therapy, but not taken medication yet.
I have taken medication, but not tried therapy yet.
No, I haven’t tried either of these options yet.


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3. Do you still have symptoms that haven’t fully improved?
Yes
No

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Your Quiz Results
According to your responses, you may be a candidate for TMS therapy.
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