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Initial Screening
Request For A Free Initial Screening Appointment
Zoya Clinic is a fee for service tele-health practice and is
NOT
in contract with any insurance companies at this moment.
Our providers are licensed in Minnesota and only provide care via tele-health to patients residing in
Minnesota
.
This request is not regarding a medical or mental health emergency.
Completing this form does not establish doctor-patient relationship.
SEE OUR RATES
YES, i understand
WHICH PROVIDER WOULD YOU LIKE TO CONSULT? *
Select one
Dr. Hadizadeh (women's mental health only)
Dr. Salehi (child and adolescent only)
What services are you seeking to begin or continue care for? *
Select one
Medication management
Hormone therapy
Psychotherapy
Full Name *
Date of birth *
Email Address *
Phone number *
HOW DID YOU HEAR ABOUT US?
Select one
A current patient
Google Ad
Google Search
My therapist
Psychology Today
WebMD
None
* Required Field
Thank you! Your submission has been received!
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