The following form allows you to enter information to pre-register for an appointment. You will be contacted once the information is received and processed. Attempts will be made to contact you on the days and times specified.

 

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Please note that when you are contacted, someone from our registration and scheduling department will be going over the information you provide here for the purpose of verification.
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Please allow two business days for a response to your request to schedule an appointment. If information is submitted on a weekend, it will be processed on the next business day.
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IF YOU ARE EXPERIENCING AN EMERGENCY, PLEASE CALL 911, VISIT YOUR LOCAL EMERGENCY ROOM OR CALL 1.800.342.5653 TO CONTACT A LIVE PERSON

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Your Northern Indiana Community
Mental Health Center

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