Please fill out the form below to request an appointment with Minnesota Mental Health Clinics. You will be contacted to schedule an appointment within the next 3 business hours (Monday – Friday, 9am to 5pm) at the phone number you provided. Client Name (required) Client Date of Birth (required) Client Phone Number (required) Primary Contact (if different from client) Contact Phone Number Contact Relationship to Client Best Time to Contact Email Address Do you have Medicare as your primary or secondary insurance? NoYes Insurance Name Insurance ID What service would you like to schedule? —Please choose an option—Individual TherapyFamily TherapyADHD TestingAdolescent Group TherapyAdult Group Therapy Do you have a preferred location or locations? Apple ValleyEaganEdinaLakevilleMaplewoodMinneapolisWoodbury Do you have preferred days and/or times? Do you have a preferred therapist? Would you like to be seen in office or telehealth? In officeTelehealthEither Which is bigger, 3 or 9? Δ