Appointment Request Form

Appointment Request Form

We are honored you have chosen The Healing Project of MN to walk alongside you in your journey of seeking emotional wellness.  It is not easy to seek support, and this is your journey.  We promise to provide you with a safe space and judgment-free zone to face life's challenges for as long as you need.

Please note: This form is for new clients.  If you are an existing client, please visit the Client Portal to schedule an appointment at https://thehealingprojectmn.clientsecure.me or call/text us at the main line at 612-778-4752, and we can help you schedule an appointment!


First Name
This question is required
Last Name
This question is required
Email
Please enter a valid email
Phone Number
This question is required
What is your preferred method of communication?
Email
Phone Call
Text
This question is required
Please enter your date of birth, including year.  Please note we do not serve minors under the age of 15.
This question is required
Please upload your driver's license and/or state ID for proof of identification.  If you do not have it available, please skip this question for now.
Choose a file
What brings you in? If you're not sure, that's okay!
Sometimes, asking for help is the hardest step. You're doing great.
If you can, briefly describe what you are experiencing, and what motivated you to seek support today.
Sometimes, asking for help is the hardest step. You're doing great.
If you can, briefly describe what you are experiencing, and what motivated you to seek support today.
Have you ever seen a mental health professional?
Yes
No
Please choose an answer
Did you have a therapist in mind who you were interested in matching with?
Natalee Tangen, LICSW (specialties -anxiety, depression, trauma, grief/loss, and working with couples)
Oralia Ojeda, LGSW (specialties include women's issues, parenting support, family conflict, grief/ loss, gender identity, and racial identity)
No preference
Undecided- I need help selecting a therapist (No problem! We are great matchmakers!)
This question is required
Best time for a therapy appointment
Morning
Afternoon
Evening
Weekend
I'm flexible!
Other
This question is required
Which service are you requesting an appointment for?
Individual, Couples or Family Therapy- Utilizing Insurance
Individual, Couples or Family Therapy- Private Pay
Low-Cost Therapy- $20 each session (offered Fridays 3:00-7:00 pm; service guaranteed; no insurance required)
Teen Talk Therapy- $10 each session (offered for 16-17 year olds; verification of age required; no parental/ guardian consent required by MN State Law; no insurance required)
FREE Drop-in Therapy (offered Fridays 11:00 am - 3:00 pm; no insurance required; we will follow up to provide you the Zoom link; Please note: depending on the influx of drop-in clients, we cannot guarantee we can serve everyone each drop-in session)
This question is required
If using insurance, please upload your insurance card (front and back).  If you do not have it available, please skip this question for now.  Please note: If we are not in-network with your insurance company, we can provide you with a Super Bill for your specific insurance company.  Otherwise, we encourage you to check out our Low-Cost Therapy Model or Free Drop-In Therapy Model if private pay or out-of-network billing is not an option while we wait on pending applications with other insurance companies! We are currently in-network with BCBS-MN, IMCare, Straight Medical Assistance, PrimeWest Health, and South Country Health Alliance.
Choose a file
Submit


The Healing Project of MN, LLC
1400 Van Buren Street NE
Minneapolis, MN 55413

www.thehealingprojectmn.org
Intake: 612: 778-2754