APPOINTMENT REQUEST

Request an Appointment

Select an available date and time, provide your contact information, and submit your appointment preferences for review.

BEFORE YOU BEGIN

Prepare to Request an Appointment

Review these important details before selecting an available date and submitting your appointment request.

Choose a Service

Select the counseling or assessment service that best matches your current needs. You may also continue without choosing a specific service.

Select Availability

Choose from the dates and appointment times currently displayed as available in the scheduling calendar.

Submit for Review

Your request must be reviewed by a Mended Minds representative before the appointment date and time are confirmed.

How It Works

Request, Review and Confirmation

Select the service and appointment format you prefer.
Provide accurate contact information.
Choose an available date and exact appointment time.
Review your information and submit the request.
A Mended Minds representative reviews the request before confirmation.

Submitting this form does not create a confirmed appointment.

This form is not intended for emergencies or sensitive medical information.

Step 1 of 4

Select a Service and Appointment Format

Choose the service you are interested in and indicate whether you prefer an in-person or virtual appointment.

Service

Leave this unselected when you need help choosing a service.

Appointment Format

Availability depends on the selected service and client eligibility.

In Person Fayetteville office

Virtual For eligible Georgia residents

No Preference Discuss available options

Step 2 of 4

Tell Us How to Reach You

Provide accurate contact information so Mended Minds can follow up regarding your request.

First Name

Last Name

Email Address

Phone Number

Preferred Contact Method

Step 3 of 4

Choose an Available Date and Time

Select an available date and then choose one of the exact appointment times shown.

Loading calendar…

Loading available dates…

Step 4 of 4

Review Your Appointment Request

Confirm that your information is correct before submitting the request.

Additional Scheduling Notes

You may provide a brief scheduling note. Do not include diagnoses, medical histories, medications, Social Security numbers, insurance identifiers, or emergency information.

Important Form Limitations

This form is for scheduling purposes only. Do not submit sensitive medical information or use this form for an emergency.

AFTER YOU SUBMIT

What Happens After Your Request

Submitting the form begins the scheduling process but does not create a confirmed appointment.

Request Review

A Mended Minds representative reviews the selected service, date, time, appointment format, and contact details.

Follow-Up Contact

A team member contacts you using your preferred contact method to discuss availability and any required next steps.

Appointment Confirmation

The appointment becomes confirmed only after Mended Minds communicates the final scheduling details to you.