Request a New Patient Appointment Tell us a little about yourself and what you’re looking for. We’re here to help. Step 1 of 2 50% About YouI am requesting this appointment for: Myself My child Someone else Please explain:Patient's First Name(Required) First Patient’s Insurance:(Required) BCBS Sanford Health Plan ND Medicaid BCBS Medicaid Expansion Medicare (only accepted for testing appointments) A Medicare Advantage plan Other I don’t have insurance but would like to hear about self-pay options. I’m interested in:(Required) Individual therapy Group therapy Couples therapy Psychiatric medication Psychological testing I’m not totally sure but would like to discuss options. (Check all that apply) Contact PersonShould we contact you or someone else (e.g., a parent or caregiver)?(Required) Me Someone else Contact Person’s First name(Required) First Contact Person’s Phone Number(Required)Contact Person’s Email Address(Required) Email Address Confirm Email Address
