Mindstrong makes getting help easy.

After you fill out our simple registration form, a care concierge will reach out to answer any questions that you might have about our services, insurance eligibility, payment options, and more.

Your info is safe with us.

Just like your doctor’s office would, we adhere to strict HIPAA and Protected Health Information (PHI) compliance.

Test form for paid ad leads - short version for Brock

"*" indicates required fields

First Name*

Last Name*

Phone*

Email*

Date of Birth*

Mindstrong cannot provide services to anyone under the age of 18.

State

By submitting this form, I give Mindstrong permission to contact me about receiving services and verifying information.

Name

This field is for validation purposes and should be left unchanged.