For Providers

Make a referral

Submit a referral to Minnesota Mental Health Clinics. Our intake team typically responds within one business day. For urgent same-day coordination, call us at (651) 454-0114.

Referring Individual

First name

Last name

Credential

Title (optional)

Clinic / organization

Phone

Patient being referred

Patient first name

Patient last name

Date of birth

Phone

Email (optional)

Insurance carrier

If Medicare, select "Medicare/Medicare Replacement Plan".

Urgency

Preferred contact for scheduling

Patient directlyThrough me (the referrer)

Reason for referral

I confirm I have authorization to submit this referral and that the patient (or their legal guardian) has consented to MMHC contacting them. I have read and agree to the Privacy Policy and Terms of Service.

Or call (651) 454-0114