New Patient Consultation Appointment Request

Please complete the form below if you are requesting a NEW Patient Consultation Appointment at iSpine Clinics. We will do our best to get back to you within one business day.

If you are an EXISTING patient, HIPPA requires you to visit our Patient Portal to book an appointment, request a medication refill, or discuss your care plan. You can also call 763-201-8191 to speak to our team directly.

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Type of Inquiry*

Consultation/New Patient

General Inquiry

Name*

Email*

Phone*

Date of Birth*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Message*

NOTICE: We are currently experiencing an unexpected outage affecting our phone, fax, and printing systems. While we do not have a confirmed restoration time, we are hopeful services will be back within approximately 48 hours. We apologize for the inconvenience and appreciate your patience.

(763) 201-8191

New Patient Consultation Appointment Request

(763) 201-8191

General Fax (763) 201-8192

Referral-only Fax (952) 303-4027