Appointment Request
Thank you for contacting Main Street Family Services. Please fill out the information below to request your first appointment.
Personal Information:
Gender of Legal Record:*
Contact Information
Address
Please select a Provider:
Your Information is confidential. However, if you are uncomfortable fully describing your reasons for seeking services, please provide enough information so our staff can match you with the appropriate provider.
Insurance:
Submit
Cancel

Appointment Request

Thank you for contacting Main Street Family Services. Please fill out the information below to request your first appointment.
Personal Information
Contact Information
Phone

Address

Please Select a Provider:
Please explain the reason you are seeking help at this time:
Insurance
Submit
Cancel
Clinic Address
400 Jackson Ave Suite 101
Elk River, MN 55330-3926
Billing Address
400 Jackson Ave
Elk River, MN 55330-3926
Phone
Business Hours
varies