Ballard Clinic | Contact & Location

Appointment Inquiry

New/Interested Clients: If you would like more information or to inquire about scheduling a first-time appointment, please complete the form below OR call 612‐787-2344 and press 1. After you submit this form, an administrative team member will contact you within one business day.

Existing Clients: To schedule or change an appointment, please reach out to your therapist directly or call 612-787-2344 and press 2.

As you compose your message, please keep in mind that this form is not for emergency use and that electronically delivered messages are not guaranteed confidential.

* Indicates required field

Client's Name *

First

Last

Client's Date of Birth *

Phone Number *

Address (Street, City, State, Zip) *

Insurance Coverage *

BCBS (in-network) PreferredOne (in-network) Aetna (in-network) Other (out-of-network)

Parent's Name (if applicable) *

First

Last

Client's Gender *

Email *

Concerns/Struggles *

Preferred Location *

Edina Wayzata Either

Referral Source *

Submit