Appointment Request
Thank you for your interest in scheduling a therapy session. To help us accommodate your needs, please fill out the information below. We will contact you as soon as a spot becomes available that matches your preferences.
Current Availability: Monday
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 (Tuesday's 10-4; Wednesday's 11-5)
Parasol Wellness Collaborative: 9201 Quaday Ave NE, Ste 205, Otsego MN 55330 (Monday's 10-5)
First Available
What day and time do you prefer? (Select all that apply)
* Monday - - Anytime/I am flexible
Monday’s 10 am - 12 pm
Monday's 1 pm - 3 pm
Monday's 3 pm (waitlist)
Monday's 4 pm (sporadic openings)
* Tuesday - - Anytime/I am flexible
Tuesday's 10 am - 11 pm (waitlist)
Tuesday's 1 pm - 3 pm (waitlist)
Tuesday's 3 pm (waitlist)
* Wednesday - - Anytime/I am flexible
Wednesday's 11 am - 3 pm (waitlist)
Wednesday's 3 pm (waitlist)
Wednesday's 4 pm (waitlist)
What is the general issue you would like to work on?
Submit
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