Minneapolis Health Clinic After Hours Appointment Request Form

Appointment Request Form

Let us know how we can help you!
Call: 763-496-5708. Location: 4825 Olson Memorial Hwy, Suite 101, Golden Valley, Minnesota 55422
Full Name*

First NameLast Name
Contact Number*
Please enter a valid phone number.
Email Address*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Select applicable need*

After-hours appointment (Telemedicine. States covered: Minnesota, Wisconsin, Kansas, Iowa, and Illinois)USCIS Citizenship Exam Disability Exemption Consultation (Medical Records Needed)Focussed Primary Care ConsultationImmigration Medical ExamMedical Consultation or Service in your home or office (wellness hydration, weight loss, physical therapy, etc)Tirzepatide Weight Loss ProgramPersonalized Genetic Testing about your wellness and disease riskFatty liver and liver disease risk scansMental Health Consultations (States covered: Minnesota and Arizona)ADHD Assessments (States covered: Minnesota, Alabama and Arizona)Direct Primary Care (DPC)Concierge ServiceMonaLisa Touch (vaginal wellness)Lutronic Ultra (treat skin disorders i.e. melasma, hyperpigmentation, acne)
Note: We accept CareCredit, HSA and medical insurance as a payment option and we cover multiple states. Please note that not all services are covered by medical insurance.
Upload your insurance card or relevant medical information

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Appointment Request Form