Contact Us

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Schedule Directly on CareCloud

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Request Your First Visit

If you've already sent the "Request Your First Visit" form above, continue below for any follow-up questions.
Pay Your Bill Online
Please use the TMS Contact Form or click here to learn about TMS.
Please use the Esketamine Contact Form
Release Information from MTC

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Use the link below if you need us to complete a disability or FMLA form.
Disability & FMLA Request

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Got questions about scheduling, refills, or administrative matters? Please don't contact your provider about those (use the admin department above).

Is it a complex issue you're writing about? We may be able to give initial guidance, but it’s best to schedule an office visit or phone consultation as well.
Name*
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Secondary Phone
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Pharmacy Name
Pharmacy Phone
Medication Names*
List meds you need refilled or authorized. Tell us if you are taking them differently than prescribed.
If you've been off your medications for more than 3 days, let us know when you last took them. It may not be safe to restart at your old dose.
We'll get back to you by the next weekday for treatment issues. For emergencies, call our 24 hour line: (336) 525-9090

Mood Treatment Center
713 SW Marshall Street
Winston-Salem, NC 27101-5808