Request Appointment

Let’s Get to Know You

We want to learn more about what’s bringing you to us. The following steps will help us better understand your experiences, goals, and care preferences. Our team will contact you shortly.

Friendly note: At this time, we provide in-office, medication management services only. We don’t offer therapy-only appointments—not because we don’t love good conversation, but because therapy takes the kind of time and continuity our schedule just doesn’t allow right now. Our focus is on helping you find the right medication support to keep you moving forward.

Disclaimer: While this website is encrypted, data security cannot be guaranteed. Communications through this site are not confidential, and there is no expectation that health data will be protected. Submitting this form does not create a provider-patient relationship. By providing your information, you consent to be contacted by M.I.N.D. Health and Wellness via email, phone, or SMS. Message frequency may vary; message and data rates may apply. By continuing on our website, you are deemed to have agreed to these terms and conditions. You can also view our privacy policy to learn more or contact us via our HIPAA-compliant platform.

Patient's Legal Name
Address
Email
Choose wisely as this email will be connected with your online medical record log in.
We see patients ages 5–60.
Check this box if you need to also enter another point of contact, which will help manage the patient’s medical records or assist in treatment decisions.
How will we meet?
At this time, M.I.N.D. Health and Wellness requires all new patient and initial intake appointments to be completed in person. After the initial evaluation, follow-up appointments may be offered virtually when appropriate and based on the individualized treatment plan developed with your provider.
This helps us know how to better help others.
Please share how you heard about us or who referred you.

Do you take my insurance?

You can find out what insurance plans we accept by clicking here.

For added peace of mind, you can also upload a front and back copy of your insurance card, and we’ll confirm your insurance eligibility status.

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