Poehailos, Dupont and Associates | Charlottesville mental health

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Main Office
887 B Rio East Court
Charlottesville, VA 22901
Phone: (434) 220-4686
Fax: (434) 220-4687

Satellite Office
199 Spotnap Road, Suite 4
Charlottesville, VA 22911
Phone: (434) 995-5600
Fax: (434) 995-5620

Serving the mental health needs of Virginia's families

Patient Registration

Please come 15 minutes early for your first appointment!

Information to read:

Patient Information

Fees

HIPAA and Privacy Practices

Forms to complete for your initial appointment:

Child Patient Registration (ages 2 - 11)

Adolescent Patient Registration (ages 12 - 17)

Adult Patient Registration

Authorization for Release of Information

Consent for Electronic Communications

Informed Consent for Mental Health Treatment by Video Conferencing

Contract for Psychiatric Evaluation