Behavioral health clinic

Upperbrook Hollow Behavioral Health · Behavioral health clinic · Brattleboro, VT

Carys Wainwright is the intake coordinator at Upperbrook Hollow Behavioral Health, an outpatient behavioral health clinic, and relies on it to carry each person who asks for care from the first contact through screening and forms to a first appointment on the calendar.

Healthcare IntakeForms4 tables · 6 views · 3 forms · 2 dimension sets · 1 digest · 1 notification · 1 stage rule set · 1 agent

Use this template

Request board

New client requests

New request5

Ainsworth: adult therapyBH-4100Marguerite Ainsworth-Delacroix

Bellweather: teen therapyBH-4107Tobias Bellweather

Castellanos: couples counselingBH-4114Ximena Castellanos-Reyes

Dunmore: medication evaluationBH-4121Wilhelmina Dunmore

Eberhardt: substance use supportBH-4128Kwabena Eberhardt-Osei

Screening call done4

Fairweather: adult therapyBH-4135Lorcan Fairweather

Galloway: teen therapyBH-4142Saoirse Galloway-Ito

Pennywhistle: group programBH-4149Rosalind Pennywhistle

Ivanhoe: adult therapyBH-4156Thandiwe Ivanhoe-Mbeki

Paperwork sent5

Jessop: medication evaluationBH-4163Caspian Jessop

Kowalczyk: couples counselingBH-4170Perpetua Kowalczyk-Brandt

Tolliver: adult therapyBH-4177Casimir Tolliver-Varga

Marchetti: teen therapyBH-4184Nalini Marchetti-Oduya

Nightingale: substance use supportBH-4191Rufus Nightingale

Paperwork back3

Oyelowo: adult therapyBH-4198Briar Oyelowo-Strand

Pemberton: medication evaluationBH-4205Gwendolyn Pemberton

Quillfeather: group programBH-4212Aurelio Quillfeather

First visit booked6

Rasmussen: adult therapyBH-4219Folasade Rasmussen-Adeyemi

Sutherland: couples counselingBH-4226Percival Sutherland

Thackeray: teen therapyBH-4233Chidimma Thackeray-Nwosu

Underhill: adult therapyBH-4240Marigold Underhill

Vanderhoek: medication evaluationBH-4247Leopold Vanderhoek-Mensah

1 more

Seen6

Xanthopoulos: adult therapyBH-4261Isidore Xanthopoulos

Yarborough: adult therapyBH-4268Winifred Yarborough-Kasprzak

Zimmerman: teen therapyBH-4275Chukwuemeka Zimmerman-Okafor

Abernathy: couples counselingBH-4282Delphine Abernathy-Soto

Brockhurst: group programBH-4289Anselmo Brockhurst

1 more

Waitlisted1

Dellacroce: adult therapyBH-4303Hartley Dellacroce

Declined2

Eastwick: substance use supportBH-4310Anjali Eastwick-Banerjee

Fenchurch: adult therapyBH-4317Ludovic Fenchurch

Tables

New client requests

32 sample rows · 24 columns

Everyone who asked for care, from the first request through screening, forms and a booked first visit.

Request	Request number	Client	Phone	Email	Date of birth	Care wanted
Eberhardt: substance use support	BH-4128	Kwabena Eberhardt-Osei	(802) 555-0154	kwabena.eberhardtosei@northmeadowpostbox.net	May 21, 1986	Substance use support
Ainsworth: adult therapy	BH-4100	Marguerite Ainsworth-Delacroix	(802) 555-0150	marguerite.ainsworthdelacroix@northmeadowpostbox.net	Jan 1, 1958	Adult therapy
Bellweather: teen therapy	BH-4107	Tobias Bellweather	(802) 555-0151	tobias.bellweather@elmgatemailhub.com	Feb 6, 1965	Teen therapy
Castellanos: couples counseling	BH-4114	Ximena Castellanos-Reyes	(802) 555-0152	ximena.castellanosreyes@northmeadowpostbox.net	Mar 11, 1972	Couples counseling
Dunmore: medication evaluation	BH-4121	Wilhelmina Dunmore	(802) 555-0153	wilhelmina.dunmore@elmgatemailhub.com	Apr 16, 1979	Medication evaluation
Fairweather: adult therapy	BH-4135	Lorcan Fairweather	(802) 555-0155	lorcan.fairweather@elmgatemailhub.com	Jun 26, 1993	Adult therapy
Fenchurch: adult therapy	BH-4317	Ludovic Fenchurch	(802) 555-0181	ludovic.fenchurch@elmgatemailhub.com	Aug 21, 1983	Adult therapy
Galloway: teen therapy	BH-4142	Saoirse Galloway-Ito	(802) 555-0156	saoirse.gallowayito@northmeadowpostbox.net	Jul 4, 2000	Teen therapy
Jessop: medication evaluation	BH-4163	Caspian Jessop	(802) 555-0159	caspian.jessop@elmgatemailhub.com	Oct 19, 1973	Medication evaluation
Pennywhistle: group program	BH-4149	Rosalind Pennywhistle	(802) 555-0157	rosalind.pennywhistle@elmgatemailhub.com	Aug 9, 1959	Group program
Eastwick: substance use support	BH-4310	Anjali Eastwick-Banerjee	(802) 555-0180	anjali.eastwickbanerjee@northmeadowpostbox.net	Jul 16, 1976	Substance use support
Kowalczyk: couples counseling	BH-4170	Perpetua Kowalczyk-Brandt	(802) 555-0160	perpetua.kowalczykbrandt@northmeadowpostbox.net	Nov 24, 1980	Couples counseling

20 more rows

Calls and messages

46 sample rows · 6 columns

Each screening call, text or email with a person asking for care, and how it went.

Note	Request	Channel	Outcome	Contacted on	Minutes
Screening call: Lorcan Fairweather	Fairweather: adult therapy	Call	Screened	Oct 15, 2026	21
Screening call: Saoirse Galloway	Galloway: teen therapy	Call	Screened	Oct 13, 2026	24
Sent the forms packet: Caspian Jessop	Jessop: medication evaluation	Email	Forms sent	Oct 13, 2026	11
Screening call: Rosalind Pennywhistle	Pennywhistle: group program	Call	Screened	Oct 11, 2026	27
Screening call: Caspian Jessop	Jessop: medication evaluation	Call	Screened	Oct 11, 2026	33
Sent the forms packet: Perpetua Kowalczyk	Kowalczyk: couples counseling	Email	Forms sent	Oct 11, 2026	8
Screening call: Anjali Eastwick	Eastwick: substance use support	Call	Screened	Oct 10, 2026	20
Screening call: Thandiwe Ivanhoe	Ivanhoe: adult therapy	Call	Screened	Oct 9, 2026	30
Screening call: Perpetua Kowalczyk	Kowalczyk: couples counseling	Call	Screened	Oct 9, 2026	22
Sent the forms packet: Casimir Tolliver	Tolliver: adult therapy	Email	Forms sent	Oct 9, 2026	12
Sent the forms packet: Briar Oyelowo	Oyelowo: adult therapy	Email	Forms sent	Oct 9, 2026	10
Sent the forms packet: Isidore Xanthopoulos	Xanthopoulos: adult therapy	Email	Forms sent	Oct 9, 2026	11

34 more rows

Referring offices

9 sample rows · 6 columns

The doctors, schools and programs that send people, and how many requests each one brings.

Office	Kind	Office phone	Sending clients since	Requests
A friend or family member	Word of mouth	—	Oct 18, 2021	Rasmussen: adult therapy, Abernathy: couples counseling
Cobalt Ridge Employee Assistance	Employee assistance	(802) 555-0125	Oct 18, 2023	Fairweather: adult therapy, Quillfeather: group program, Brockhurst: group program
Found us online	Self-referral	—	Oct 18, 2021	Castellanos: couples counseling, Pennywhistle: group program, Kowalczyk: couples counseling, Oyelowo: adult therapy, Sutherland: couples counseling, Xanthopoulos: adult therapy, Fenchurch: adult therapy
Hartwell Primary Care	Primary care	(802) 555-0121	Oct 18, 2022	Ainsworth: adult therapy, Dunmore: medication evaluation, Jessop: medication evaluation, Pemberton: medication evaluation, Vanderhoek: medication evaluation, Yarborough: adult therapy
Larch Valley Pastoral Care	Faith community	(802) 555-0126	Oct 18, 2024	Ivanhoe: adult therapy, Whitcombe: substance use support
Marlow Union School counselors	School counselor	(802) 555-0122	Oct 18, 2023	Bellweather: teen therapy, Thackeray: teen therapy, Zimmerman: teen therapy
Pinecrest Pediatrics	Pediatrician	(802) 555-0123	Oct 18, 2022	Galloway: teen therapy, Marchetti: teen therapy, Dellacroce: adult therapy
Riverbend Hospital crisis unit	Hospital	(802) 555-0124	Oct 18, 2024	Eberhardt: substance use support, Nightingale: substance use support, Underhill: adult therapy, Calloway: medication evaluation
Thornfield Urgent Care	Urgent care	(802) 555-0127	Oct 18, 2025	Tolliver: adult therapy, Eastwick: substance use support

Also included

Request boardStage rules
Forms still outDigest
New requestNotificationTells the intake coordinator the moment someone asks for care, so the screening call happens within a day.

Med spaSaltmarsh Light Medical Aesthetics4 tables · 6 views · 1 form · 2 dimension sets · 1 digest · 1 document · 1 notification · 1 stage rule set · 1 agentGoverned columns

Mobile phlebotomyUmberfield Mill Mobile Lab4 tables · 6 views · 1 form · 2 dimension sets · 1 booking page · 1 digest · 1 document · 1 notification · 1 stage rule set · 1 agentBookings

Occupational therapy clinicIronbridge Fields Occupational Therapy4 tables · 5 views · 1 form · 1 digest · 1 notification · 1 agentGoverned columns

Ardith Solheim-Banda	KH-10401	Mar 14, 1946
Cornelius Whitlock-Abara	KH-10402	Nov 2, 1951
Theodora Brandt-Nakamura	KH-10403	Jul 21, 1943
Everett Kowalczyk-Ruiz	KH-10404	Jan 30, 1958

Corinne Abernathy-Voss	HDG-41200	Feb 17, 1986
Hamid Zahradnik-Dunn	HDG-41207	Sep 3, 1979
Linnea Bergstrom	HDG-41214	Nov 26, 1992
Odell Fitzgerald-Park	HDG-41221	May 14, 1968

Ludovica Ashgrove-Okoye	Mar 14, 1991	(608) 555-0150
Tobiah Wynnstay	Nov 2, 1978	(608) 555-0151
Marisela Whitlow-Ndiaye	Jun 25, 2001	(608) 555-0152
Cuthbert Oyelaran-Fry	Sep 9, 1962	(608) 555-0153

Winola Brandvik-Seabrook	(843) 555-0120	winola.brandvikseabrook@lowcountrymailbox.net
Cassius Delacroix-Oyelowo	(843) 555-0121	cassius.delacroixoyelowo@lowcountrymailbox.net
Marisol Tamayo-Keane	(843) 555-0122	marisol.tamayokeane@lowcountrymailbox.net
Winifred Ashgrove	(843) 555-0123	winifred.ashgrove@lowcountrymailbox.net

Kilbride — fasting lipid panel	Fasting lipid panel	Yes
Mackenzie — complete blood count	Complete blood count	No
Vickery — prenatal panel	Prenatal panel	No
Yankowski — metabolic panel	Metabolic panel	Yes

Calla Rydell	IFO-26-101	Hand and wrist therapy
Ignatius Okwuosa	IFO-26-102	Pediatric sensory and fine motor
Wilhelmina Haverbrook	IFO-26-103	Stroke recovery
Tobiah Tennyson-Cole	IFO-26-104	Workplace injury and ergonomics

Request board

Tables

New client requests

Calls and messages

Referring offices

Also included

Related templates