New Client Inquiry
Please share a few details so we can connect you with the right therapist. Our team will follow up with next steps.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone
-
Area Code
Phone Number
What concerns would you like support with? (Optional)
You may share as much or as little as you'd like.
Preferred Appointment Times (check all that apply)
*
Morning (8am-12pm)
Midday (12pm-2pm)
Afternoon (3pm-5pm)
I do not have specific scheduling needs
Preferred Appointment Type
In-Person
Telehealth
Either
Billing and Insurance
Please Select
In-Network Insurance (BCBS, HealthPartners, Cigna, UCare, Medicaid)
Out-of-Network Insurance (United Behavioral Health, UMR, Medica)
Out-of-Pocket
I'm Not Sure
Are you ready to schedule your first appointment?
Yes
I have questions first
How did you find us?
Google Search
Psychology Today
Good Therapy
Direct Referral
Family or Friend
Insurance Information
Optional: Uploading your insurance card helps us verify your benefits before scheduling. If you don’t have it now, you can provide it later..
Insurance Card - Front (Optional)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Insurance Card - Back (Optional)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
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