Request an Appointment Schedule an Appointment Name* First Last Date You Plan to Arrive* MM slash DD slash YYYY Time You Plan to Arrive* 8:00am9:00am10:00am11:00am12:00pm1:00pm2:00pm3:00pm4:00pm5:00pm6:00pm7:00pm Phone* Email* Insurance* I have Insurance Self Pay - Do not have Insurance Name of Insurance Co/Plan* Member ID #* Group #* Policy Holder Name* Date of Birth* MM slash DD slash YYYY Relationship to Policy Holder (self, spouse, parent)* Medical History (Any health concerns we should be aware of (diabetes, seizures, high blood pressure, etc) Anything you would like us to know in regards to your upcoming visit? Type any info you would like us to know, why you are coming, any questions you may have, etc A member of our experienced Valley Hospital team will be in touch with you soon! Categories Addiction Mental Health News Recovery