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Return Appointment Contact Request Form

If you are already an established MHNI patient and would like to request an appointment, please submit the following secure form. An Appointment Scheduler will contact you via phone within 1-business day to discuss your request and schedule your appointment. Fields marked with an * are required.

If you have never been seen at MHNI, please use the New Patient Headache/Pain Contact Request Form

Please note that not all scheduling requests can be honored. Some appointment types require additional time, services, physician referrals, and insurance authorizations.

 

Contact Information
Appointment Request Information/Preferences

Please note that not all providers are available on all days of the week.  Please indicate the following as a preference—availability is not guaranteed.

Who would you like to schedule your appointment(s) with? (check all that apply)

Current Appointment Cancellation Request
Message For MHNI Appointment Scheduler:

The message area below should not be used by individuals who have a clinical circumstance under question which needs direct involvement of a medical professional. Individuals who need direct involvement of a medical professional should contact him/her directly. Please use this area solely to provide information that would be of value to the MHNI Appointment Scheduler.

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