Bloom Mental HealthLas Vegas · (702) 350-1419

Request an appointment

Tell us a little about what you need and the best way to reach you. A person from our team calls or emails you back to set a time. Nothing here goes to an automated line.

First name

Last name

Mobile phone

Email

I am looking for

New patient evaluation Medication follow-up Therapy Not sure yet

Who is the appointment for

Me My child Someone I care for

Visit preference

Video visit In the office Either

Best days and times to reach you Paying with

Insurance Self pay Not sure

Insurance plan (if you know it)

Anything you want us to know before we call (optional)

It is okay to contact me by phone, text or email about this request.

This form is for scheduling only. Please do not include medical details you would not want in an email. Sent over an encrypted connection to Bloom Mental Health's practice system.

If you are in crisis or thinking about harming yourself, call or text 988 (Suicide and Crisis Lifeline) or call 911. This form is not monitored around the clock.