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.
A few details
So the office has what it needs when they call to schedule your visit.
We’ll confirm your request here.
Please fill in the highlighted fields.
Your insurance (optional)
Adding it now saves paperwork at check-in. You can skip this and bring your card instead.
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.