Welcome to Strong Mind Medicine

This page is for patients or providers who would like to request care or refer someone for evaluation.

Please fill out the short form below with basic contact information. We’ll reach out directly to schedule a brief phone call and confirm next steps.
Please do not share medical history or sensitive information through this form.
If you have questions or prefer to speak directly, you’re welcome to call our office at (276)378-0164

Are you a

Patient

Provider

Family member or other

Patient Information

First Name

Last Name

Date of Birth

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DD

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Email

Subject

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Does the patient currently have government insurance?

Medicaid

Medicare

Commercial Insurance

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Referring Provider Name (if applicable)

Clinic or Practice Name (optional)