Request an Appointment

To request an appointment, please fill out the form below. One of our intake coordinators will be in contact with you to schedule your visit.

Client Information

Contact Information

Insurance Information

If able please provide your insurance information. We will receive your information securely and keep it confidential. Insurance information is not required to submit form.

Location Preference

Other Information

Prefer to call?

Make an appointment by phone, or speak with someone to learn more! Contact FamilyMeans intake department at: 651-439-4840. Due to COVID-19, please note that some staff are still working remotely and response time may be delayed.