612.767.7770

[email protected]

Search

Intake Questionnaire

Intake Questionnaire
Please complete the in-take questionnaire form and we will get in touch with you shortly. Please be aware that unless you are a parent or legal guardian, we cannot accept paperwork signed by others. 

Contact Information

Current Symptoms

Health History

Family Background and Childhood History:

As psychotherapists, our goal is to assist you in therapy to discover your true self and lead to a life worth celebrating.

Get Started

Moorhead, MN
Address: 3401 8th St. S. Moorhead, MN 56560
Phone: 218.284.2040
Fax: 218.284.2041

Minneapolis, MN
Address: 2701 University Avenue. SE. Suite 205, Minneapolis, MN 55414
Phone: 612.767.7770
Fax: 612.767.7772

Waite Park, MN
Address:
304 4th Ave. NE. Suite 3
Waite Park, MN 56387
Phone: 320-774-1184
Fax: 320-774-1176