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now accepting new patients

Before scheduling your first visit, you must set up your patient portal and complete all required intake forms so we can review your medical history and process your information correctly.

After clicking the link below, you will be asked to submit a request for an appointment. Once your request is received, you will be emailed a link to create your patient portal account. Please make sure the portal account is created successfully, as incomplete setup may prevent your paperwork from transmitting correctly.

Click below to send an email to our Admin to request to set up your Portal

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Please include the following:

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Full legal name, DOB, Insurance info

After sending your request, our admin will set up a Patient Portal for you this may take 24-48 hours or sooner and they will send instructions for logging in and completing all necessary intake forms.​ Only then can you self schedule a new intake 

Need support? Contact admin@ptpmn.org.

Why am I being redirected?

Miles Med Management works with Psychotherapy Partners, a group practice that offers professional and secure intake, billing, and administrative support for all of its practitioners and clients. You may notice their website during this process — that’s completely normal and part of your confidential setup.

New Adult Intake Form

Birthday
Month
Day
Year

Address

Address

Mental Health History Status

Past Mental Health Treatment

Have you ever been hospitalized for psychiatric reasons?
Yes
No
Have you ever had outpatient treatment by a psychiatrist?
Yes
No
Have you ever received counseling or psychotherapy in the past?
Yes
No

Please List any psychiatric medication you have taken or are taking:

Please check all that apply

General Medical History

Are you on any medications for any general medical problems you may have?
Yes
No
Do you have any allergies to medications?
Yes
No

Alcohol, Drug, and Tobacco Use

Family Medical History

List any history of illness (mental or other) and substance abuse among blood relatives

Social History

Did your parents get divorced as a child?
Yes
No
Did you go to College?
Yes
No
Do you have any children?
Yes
No

Consent to Treatment

We are treating you and we will do our best to accurately diagnose you and design a comprehensive treatment plan that will enable you to continue with a normal emotional development. This may include recommendations of therapy, or medications. This is all part of the service of a mental health professional. We will also work with your primary care physician to assure coordination of care.

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You are our client and have confidentially rights. Confidentiality does not apply under certain situation: We are obligated by law to report any suspicion of child abuse. This includes physical or sexual abuse. Also, we have a duty to protect if we suspect anyone is in danger of killing themselves or has made threats to hurt someone else.


If I require or think it is in your best interest to communicate with an outside source, I will request a release of information. To assure good therapeutic care, frequent appointments are required. A new evaluation will be required for any inactive client to be seen. Considered inactive after 12 Months.

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I am aware that I may stop treatment with this mental health professional at any time.

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I am aware that if I attempt to call my my provider through phone, email, text or any other form of communication over the internet, my information may not be completely secure. In the event that my information be intercepted, this clinic is not responsible for the breach of patient privacy. Below are the approved contact means to leave messages on or respond to if contacted.  

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CONTACT

PHONE: 612-708-7562

FAX : 507-738-1963

3507 Lyndale Ave S. Minneapolis, MN 55408

You may receive encrypted emails from ‘Paulbox’ on behalf of Miles Med Management.

​Copyright © 2025 Mental Health Meds. All Rights Reserved.

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