Your Phone Number *

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Would you be interested in virtual sessions? *

Yes

No

Select all boxes that may fit your availability.

Daytime

Evenings

Weekends

Select insurance plan or option to self pay. *

Blue Cross Blue Shield

Health Partners

Preferred One

Ucare

Medical Assistance

Hennepin Health

Cigna

Aetna

United Medical Resources (UMR)

Tricare * please note only a few of our clinicians accept this plan.

United Healthcare or Medica * please note only a few of our clinicians accept these plans.

No Insurance / Self Pay Rate of $145 per hour

Disclosure *

By checking this box, I understand that my first name, phone number, email address and the information I provided will be sent to intentionalself@gmail.com. I understand that this is an electronic message and may be visible to others. I have included only information that I am comfortable disclosing electronically. I understand that a staff member will call, text, or email me.