Primary Clinics

Health care that starts with people care.
Primary Clinics

New Clinic Patient Appointment Request

Welcome to HealthEast Clinics! This form is for new patients only. You can also call to schedule your appointment at 651-326-CARE (2273). If you prefer to have someone call you back to schedule your appointment, complete the following information and we will attempt to contact you twice by phone within two business days. This form is for non-urgent appointment requests. If this is an urgent medical concern, call your doctor’s office or 911.

For current patients: Please do not use the form below. Existing HealthEast MyChart users can schedule visits through MyChart with their provider or call 651-326-CARE (2273).

*Required fields

Requestor Information

First name*
Please enter your first name.

Last name*
Please enter your last name.

Daytime phone*
Please enter your 10 digit phone number.

  xxx-xxx-xxxx

Alternate daytime phone
Please enter your 10 digit phone number.

  xxx-xxx-xxxx

Preferred clinic*
Please select a clinic

Patient Information

Please enter patient name, if different from above.

First name
Please enter your first name.

Last name
Please enter your last name.

Patient date of birth*
/ / Please enter the patient's date of birth