Charm schedule MJ - Skycloud Health

Do you prefer to register online or by phone?

I understand that only the patient or their legal guardian should complete this form.

I am the:

The potential patient, or their parent/guardian, must fill out this form. Identification will be requested during the process. If they are not available, please direct the potential patient to this page at a later time. Health care providers can find referral information here.

We are taking patients ages 13-17 with certain specified insurance panels in OR, WA, and UT. “You” in the following slides refers to the potential patient.

Are you seeking psychotherapy, medication management, or another evaluation type?

We are currently accepting new clients for psychiatric evaluations. Our psychotherapy caseload is full but you can contact us to learn more and join the waitlist.

Contact Us

Our psychotherapy caseload is full. Patients in OR, WA and UT can join our waitlist by clicking the button below.

Learn more about psychiatric evaluations, which can help you determine a treatment plan. Call us at 503-694-3391 or email admin@skycloudhealth.com with any questions.

Limitations of Skycloud:

– We do not offer evaluations for disability or legal reasons.
– Opioid use disorder treatment is only offered in Oregon, Washington, and Utah.
– We do not see clients under 13.

Resources

Have you attempted suicide in the past?

When was your most recent suicide attempt?

Unfortunately we do not have clinicians who are able to treat you via telehealth at this time. Please contact clinic at (503) 694-3381 with questions and check our list of resources.

See Resources

Have you ever been hospitalized in a psychiatric unit or stayed in a residential mental health facility?

When was your most recent hospitalization or stay in a residential mental health facility?

Where do you reside?

We are only offering services in Oregon, Washington, Utah, New Mexico, Arizona, Minnesota, and Nevada at this time.

See Resources

Are you currently prescribed a stimulant (e.g. Adderall, Ritalin) or benzodiazepine (e.g. Ativan, Xanax) and seeking to continue it?

We prescribe controlled substance medications (i.e. stimulants, benzodiazepines) only to patients in OR, WA and UT with a required minimum once yearly in-office visit in Clackamas OR, Issaquah WA, Lehi UT, or Layton UT when clinically appropriate (please view our stimulant policy). It may be helpful to note that in our practice, we rarely use benzodiazepines (e.g. Xanax, Ativan, Klonopin). Contact admin@skycloudhealth.com with questions.

See Resources

In-office visits are required once a year in Clackamas OR, Issaquah WA, Lehi UT, or Layton UT for patients who are prescribed controlled substances. Click “Okay” to continue.

We prescribe controlled substance medications (i.e. stimulants, benzodiazepines) only to patients in OR, WA and UT with a required minimum once yearly in-office visit in Clackamas OR, Issaquah WA, Lehi UT, or Layton UT when clinically appropriate (please view our stimulant policy). It may be helpful to note that in our practice, we rarely use benzodiazepines (e.g. Xanax, Ativan, Klonopin). Contact admin@skycloudhealth.com with questions.

See Resources

In-office visits are required once a year in Clackamas OR, Issaquah WA, Lehi UT, or Layton UT for patients who are prescribed controlled substances. Click “Okay” to continue.

We do not prescribe stimulant, benzodiazepines, Suboxone, or other controlled substances in Minnesota. If you would still like to schedule, click Okay. To see other Resources, click “Resources.”

Resources

Which insurance plan do you have?

Which insurance plan do you have?

Which insurance plan do you have?

If your insurance was not listed, we may not be in your network. Please email billing@skycloudhealth.com to verify.

See Resources

If your insurance was not listed, we may not be in your network. Please email billing@skycloudhealth.com to verify.

See Resources

We do not see clients under 13.

Our provider is in process of panelling with your insurance. You can see him at a discounted self pay rate until he is contracted. Click below to schedule.

Resources

Registration forms must be completed within 24 hours of booking or appointment will be cancelled. Forms take 15-20 minutes to complete. Please have your payment method, state ID and insurance card available.

Schedule an Appointment with Madeline Jacobs

PLEASE ENTER YOUR LEGAL FIRST NAME ON THE FIRST PAGE OF THE REGISTRATION. WE WILL ASK FOR THE NAME YOU GO BY AND DETAILS OF YOUR GENDER ON THE SECOND PAGE. THIS IS A LIMITATION OF OUR SOFTWARE.

We recommend completing the following form on a laptop or desktop if possible. You can save this link for later copying and pasting the URL.

In-Person Intake Availability with Madeline Jacobs PMHNP:Clackamas OR – TuesdaysIssaquah WA – 10/27/24 ; 1/26/25

If you do not see this as an option, you can register as a patient and contact us to move your appointment.

Please note that Madeline Jacobs serves primarily as an intake provider within our practice. This means she will help establish a treatment plan and place you with the best provider for your needs.

If you prefer to register by phone, call 503-694-3381 with code ‘INTAKE2024’.

Holistic Psychiatric Treatment at Home in OR, WA, UT, MN, AZ, NM, and NV

Get Started

Dose/Med

Med/Dose

Psychotherapy Consultation (OR)

Psychotherapy Waitlist (WA & UT)

Phone Registration

Dose/Med (UT)

Dose/Med (NM)

In-Person Intake Availability with Madeline Jacobs PMHNP:
Clackamas OR – Tuesdays
Issaquah WA – 10/27/24 ; 1/26/25