Appointment Request Form

Mindpath College Health is an outpatient mental health clinic offering individual therapy, partner therapy, group therapy, and medication management services. We do not provide treatment for substance abuse or active psychosis. 

In-office and online appointments are available at all locations. If looking for online services, 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 having a psychiatric or medical emergency, please call 911 or go to the nearest emergency room. You can also reach the National Suicide and Crisis Lifeline by calling 988 or contact the Crisis Text Line by texting HOME to 741741. 
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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