Interna Mental Health
Referral Form for Services
Client First Name
*
Client Last Name
*
Client's Pronouns (optional)
Client's phone number
*
Please enter a valid phone number.
Email
*
example@example.com
Date of Birth
-
Month
-
Day
Year
Date
Coverage Info
Client is being referred to/interested in:
*
Individual Therapy
Couple's Therapy
Family Therapy
Coaching
Group Therapy
Healing Breathwork Sessions
Retreats
Is client wanting services via telehealth or in-office?
*
telehealth/virtual
in-person (NE Minneapolis, MN)
in-person (Eagan, MN)
in-person (Inver Grove Heights, MN)
Is there a specific therapist/coach/practitioner you are interested in working with?
no preference
Taylor Baez, St. Paul or virtual *wait list
Reide Bibeau, virtual *wait list
Kaylee Bond, NE Minneapolis or virtual *wait list
Erin Donovan, Inver Grove Heights or virtual *accepting new clients
Olivia Gooley, Eagan or virtual *accepting new clients
Audrey Gunn, Eagan, NE Minneapolis, or virtual *accepting new clients
Emily Haider, Eagan or virtual *wait list
Austin Jacobson, Eagan or virtual *wait list
Kyle Johnston, Eagan or virtual *accepting new clients
Bryn Kupser, NE Minneapolis or virtual *accepting new clients
Taylor Leslie, Inver Grove Heights or virtual *wait list
Rebecca Mitchell, Eagan or virtual *accepting new clients
Samantha Rohl, Inver Grove Heights or virtual *accepting new clients
Aurora Rosenquist, Eagan, NE Minneapolis, or virtual *accepting new clients
Jen Rynes, Eagan or virtual *accepting new clients
Madeline Sandeen, Inver Grove Heights or virtual *accepting new clients
Kate Sciandra, Eagan, NE Minneapolis, or virtual *wait list
Bee Thomas, Eagan or virtual *accepting new clients
Tell us more about what you are looking for and/or your presenting concerns
*
Submit
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