Let’s work together

Name *

First Name

Last Name

Phone *

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###

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Who are you accessing services for? *

Myself

My child

Family member

I am a professional working with a client

Location Preference *

In Person (available only in Moorhead, MN)

Telehealth

Mix of Both

Will you be using insurance? *

Yes, I'll put that info below

No, I am going to be private pay

How would you like to be contacted? *

Call

Text

Email