Request Care at The Iris Center

The Iris Center provides healthcare that values time, trust, and human connection. Each relationship begins with listening and learning about who you are and what you need.

If you’re interested in becoming a patient, please complete the form. This form lets our team learn more about you and determine how we can best support your care.

Submitting this form does not automatically establish you as a patient. Once received, a member of our care team will review your request and reach out to discuss next steps.

Your Legal Name

First Name

Last Name

Your preferred name

If different from your legal name.

Sex at Birth

Current Gender Identity

Share the term or identity that best reflects how you identify.

Phone Number

The best number for our team to reach you regarding scheduling or questions.

(###)

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Your email address

We'll send patient onboarding and portal details to this address.

Insurance Carrier

Select the type of insurance you currently have. Choose "Uninsured" if you do not have coverage.

Your reason for Seeking Care at The Iris Center

Briefly share what brings you to The Iris Center or what kind of support you're seeking.