New Patient Inquiry Form

Before completion, please note:

This form is not for emergency contact. Dr. Hecht does not offer crisis services of any kind. If you are experiencing an emergency, please call 911 and/or go to your nearest emergency room. The child mental health crisis numbers for Minnesota counties can be found here.

Submission of this form will generate a message that is sent to a HIPAA compliant email address and spreadsheet monitored by Dr. Hecht. However, as with all electronic communication, this form is not secure and cannot be guaranteed as such- electronic communications can be intercepted, delayed, misdirected, amended, altered, corrupted, lost or destroyed. If you have concerns about communicating in this format or would like to share specific sensitive information about your referral, please call instead and leave a message in Dr. Hecht’s confidential voicemail box at 952-854-2622 x2.