Request your visit
Greeley, Colorado · Dr. Nicholle Peralta, M.D.
Let’s start with your name and number
So we can reach you if anything comes up before your visit.
The office will call you at this number.
Please enter your name and a 10-digit phone number.
What would you like to come in for?
Choose the visit that fits best — we’ll sort out the details together.
Have you been seen at Mindset TMS before?
This tells us what we still need from you.
A few quick questions
These help the office prepare for your call.
Any metal or implants in or around your head other than normal piercings?
Do you have a current diagnosis of depression?
Have you been prescribed any anti-depressants or any other mental health related medications?
Please answer each question.
Verify your insurance eligibility
Share your insurance now and our team can check your coverage before we call, so you can be cleared for care sooner.
Insurance card photos (optional)
or type it in
Insurers need the policyholder’s name and date of birth to find the plan.
Why we ask: it's for your benefit. With your insurance up front we can verify your eligibility much quicker. We only use it to check your coverage, and it stays private. No card handy? Leave the card part blank and continue.
We’ll confirm your request here.
Please fill in the highlighted fields.
Does this look right?
One last look before we send your request — the office will call you to find a time that works.
Visit
Location
Patient
Name
Contact
Date of birth
Insurance
Your request has been received
We’ve received your request. The office will call you to find a time that works for you, and we’ll follow up at if we can’t reach you.