Our Services / Mental Health / Request An Appointment Request An Appointment Please share our story Share on Facebook Share on Twitter Share on LinkedIn Share with your Email In-Person or Virtual? Let’s Get Started Please provide some brief information about yourself in the form below and a member of our team will be in touch with you to schedule an appointment. Your information: (all fields are required)First name* Last name* Email address* Phone number*Requested date of appointment* MM slash DD slash YYYY Preferred time* Morning Afternoon Earliest available Reason for your visit*Privacy policy* By clicking Schedule Appointment, you agree to the following Terms and Conditions.This form will be sent to Wellpoint Care Network via electronic communication. I understand that electronic communication is a convenience and not appropriate for emergencies or time-sensitive issues. Additionally, I understand that the security and privacy of electronic comunication cannot be guaranteed. Further, I understand that electronic communication should not be used to transmit highly sensitive or personal information. With regard to my protected health information, I understand that Wellpoint can send unencrypted emails ONLY if I am advised of the risks. I understand electronic messages are privileged and confidential and is covered by the Electronic Communications Privacy Act, 18 U.S.C § 2510-2521. I consent to e-mail and SMS communication with Wellpoint.
