Request an appointment

New or returning patients can request an appointment by completing an online form.

This form is for non-urgent appointment requests only. If this is a medical emergency, please dial 911. This form should not be used in an emergency. This form is being transmitted via a secure connection.

Submissions to this form are not monitored 24 hours a day. Messages are checked Monday-Friday. Please allow 1-3 business days for a response. For urgent matters, please call.

You may also speak with a representative directly by calling 320.679.1313, 7am-5pm Monday–Friday and 7am-1pm Saturdays.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Alternate Phone Number

Email(Required)

To ensure accurate scheduling in our system, please provide the patient’s full legal name and date of birth. This information is essential for scheduling appointments, whether for oneself or on behalf of another individual.

Patient Legal Name(Required)

First Last

Patient Date of Birth(Required)

Insurance

Please choose an option

Please list your insurance company's name

Are you or have you been a Welia Health patient in the past?

Yes

Briefly describe the reason for the appointment and/or diagnosis:

Are you interested in seeing a specific doctor? If yes, please give a name:

I agree to receive communications from Welia Health.

Agree

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