New patients & referrals

Request an appointment

Tell us who needs to be seen and when suits, and our intake team will call to confirm a time — usually within one business day. You can fill this in for yourself or on behalf of someone you are referring. For urgent same-day help, call (651) 454-0114.

Patient information

First name

Last name

Phone number

Date of birth

Gender

Address

Address line 2

City

State

ZIP

Appointment details

A preference, not a booking — we will call to confirm an actual time.

What are you looking for?

Not sure? Pick the closest — intake will confirm when they call.

Preferred date

Preferred time

Appointment type

Anything else we should know?

Please do not paste medical records here — attach them below instead.

Is this a referral?Tick this if you are sending someone else to us — a clinic, county worker or care team.

I confirm the details above are accurate and that the patient (or their legal guardian) consents to Minnesota Mental Health Clinics contacting them about this request. I have read and agree to the Privacy Policy and Terms of Service.

Or call (651) 454-0114