Appointment Request
Please fill out the information below and I will get back to you as soon as a spot opens up.
Current Availability: Waitlist
Please feel free to fill out the form and I will add you to my waitlist and get to you as soon as I can.
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Medical Insurance (I can't take Tricare, Medicare (65+), or EAP's)
*
Example: Anthem, Cigna, Self-Pay
Is the appointment for a Minor or Adult? I see clients 16 and older.
*
Minor
Adult
Which location do you prefer?
Northwinds Counseling: 21395 John Milless Dr., Suite 400 Rogers, MN 55374 (Wednesdays 11-6; Tuesdays 9-3)
Parasol Wellness Collaborative: 9201 Quaday Ave NE, Ste 205, Otsego MN 55330 (Mondays 11-6)
First Available
What day and time do you prefer?
Anytime/I am flexible
Monday’s 11-3
Mondays 3-6 (waitlist)
Tuesdays 9-12
Tuesdays 12-3
Wednesday's 11-3
Wednesdays 3-6 (waitlist)
What is the general issue you would like to work on?
Submit
Should be Empty: