Request appointment | Fuse Mental Health

Request an appointment

Payment method

How do you plan to pay?

Insurance Out of pocket (Intake $390.15, Follow-up $195.24)

Insurance Plan Name / Membership ID

*Required if UNABLE to upload insurance card

Insurance card upload

Upload a photo of your insurance card

*If the PRIMARY policy holder of your health insurance is your spouse/parent, we require their (1) Full Name (2) Date of Birth and, if different from you, (3) Address (4) Phone Number. Please provide this information below:

Note: If we do not have the primary health insurance policy holder information on file, payment will default to out-of-pocket.

Limited to 600 characters

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.