Appointment Request Form
MindPath College Health is an outpatient mental health clinic offering in-person and tele-mental health services.  We provide services at 7 different locations throughout the state of California and Minnesota, all staffed with both in- office and virtual providers.

We provide weekly individual therapy, couples therapy, group therapy, and medication management services to address a variety of mental health needs. MindPath College Health does not specialize in the treatment of chronic substance abuse and addiction or active psychosis.

If you are requesting telehealth services and have been redirected to this office appointment request form, please complete the form, even if you are not physically close to this office.  We have directed you here to help keep your waiting times as brief as possible.  When asked to mark ‘location’ please simply mark ‘telehealth’ in the drop-down menu.

Due to HIPAA and client confidentiality laws and ethics, the person seeking services must be the person to fill out the appointment request form. Our clinic cannot speak to parent/guardians of clients without a completed Authorization for Disclosure of Health Information on file from the client, which must be requested and signed by the client.

If you are an immediate danger to yourself or someone else, or are otherwise experiencing a mental health emergency, please call 911 or go to the nearest emergency room.

PLEASE NOTE: This form is encrypted to ensure the privacy of your information.
Any and all information disclosed on this form is confidential and will not be sold or distributed to any third parties with the exception of Insurance billing purposes.

Thank you. Our staff will be with you shortly.

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