Which state are you seeking services in?
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Minnesota
Iowa
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Method of Payment
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Health Insurance
Self-Pay
Insurance Company
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Aetna
Blue Cross Blue Shield
Cigna
Health Partners
Hennepin Health
Medica
Minnesota Medicaid
Optum Behavioral Health
Prime West
UCARE
UMR
United Behavioral Health
United Health Care
Member ID# (if using insurance)
Appointment Type
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Online (Video Call)
In-Person
Preferred Provider
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No Preference
Any Female Provider
Any Male Provider
Ebony Eromobor
Najoicia (Joi) Elmore
Antoine Jackson
Heather Gott
Lorine Williams
Ngon Ndifongwa
Bridgette Crisp
Ayan Hassan
Method of Payment
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Health Insurance
Self-Pay
Insurance Company
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Optum/United Health Group (private plan)
Member ID# (if using insurance)
Appointment Type
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Village Support currently offers telehealth therapy throughout Iowa.
Full Name (Client)
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First Name
Last Name
Date of Birth (Client)
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Guardian's name (if minor or adult under guardianship)
First Name
Last Name
Email Address
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example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Reason for Seeking Appointment
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SUBMIT
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