We will soon be offering mental health services for conditions like Anxiety, ADHD, Bipolar Disorder, PTSD, Sleep Disorders, OCD, and more. Please call us @ 612-781-1212 to schedule. ...
We make it easy by providing all the forms you need, in one place.
If you are a new patient, please fill out the registration forms listed below in advance of your appointment to assist the staff in making sure that we have all the information necessary to provide you with quality care and treatment
Multicultural Health Services - Appointment Request Form
First Name: *
Last Name: *
Date of Birth: *
Gender:
Phone:
Address:
City:
State:
Zip Code:
Reason for appointment: *
Insurance Carrier:
Insurance #:
What days’ work best for you? *
What time works best for you? *
Any additional information:
A scheduler will call you at the phone number provided to confirm the exact date and time of appointment. Thank you.
