Skip to content

info@vineyardnursingandbehavioralhealthservices.org

(626) 498-8912

For health care organizations

Facebook Instagram Linkedin X-twitter

Home
About Us
Services
- Black female therapist in California
What We Treat
Career
FAQs
Blog
Contact
Intake Form
Returning Patient Portal

Home
About Us
Services
- Black female therapist in California
What We Treat
Career
FAQs
Blog
Contact
Intake Form
Returning Patient Portal

Home
About Us
Services
- Black female therapist in California
What We Treat
Career
FAQs
Blog
Contact
Intake Form
Returning Patient Portal

Home
About Us
Services
- Black female therapist in California
What We Treat
Career
FAQs
Blog
Contact
Intake Form
Returning Patient Portal

Book Your Free Consult

Get Started Today

Vineyard Nursing and Behavioral Health Services

Schedule a Free Consultation

Home
About Us
Services
- Black female therapist in California
What We Treat
Career
FAQs
Blog
Contact
Intake Form
Returning Patient Portal

Home
About Us
Services
- Black female therapist in California
What We Treat
Career
FAQs
Blog
Contact
Intake Form
Returning Patient Portal

Therapy intake form

Therapy Intake Form

Personal Information

First Name

Last Name

Phone Number

Email Address

Reason for Consultation

Zipcode

How Did You Find Us?

How did you find out about our services?

Insurance Details

What is your health insurance carrier?

Policy / Member ID Number

Group ID

Is this your first session with us?

Yes, I'm a new client

No, I'm a returning client

Insurance Plans We Accept

We work with a variety of insurance providers to make your care as accessible and affordable as possible.

Contact

(626) 498-8912
info@vineyardnursingandbehavioralhealthservices.org
Long beach CA 90807
Fax: 626-888-6991

🕒 Hours of Operation

Mon – Fri: 9:00 AM – 7:00 PM
Sat – Sun: 9:00 AM – 5:00 PM

Links

Privacy Policy
Practice Policies
Services Fees and Appointment Cancellation Policy
Community Resources for Crisis Support & Mental Health Assistance
Partnership Form

Notice of Privacy Practice
No Suprise Act Notice

Follow

Facebook Instagram Linkedin X-twitter

Our Location

The content on this website is for informational purposes only and is not intended as medical advice.
Visiting this site or reading its content does not establish a provider–patient relationship with Vineyard Nursing and Behavioral Health Services or Olajumoke Adeyemi, PMHNP-BC. Please consult your Primary Care Provider (PCP) or a licensed medical specialist for specific medical concerns, diagnoses, or treatments.

Serving adult women (18+) across California via secure telehealth. Disclaimer: This website is for informational purposes only and does not establish a provider–patient relationship. If you are experiencing a medical or psychiatric emergency, please call 911 or go to your nearest emergency room.