Quick Intake Form

To request an appointment online please fill out the form below and someone will contact you to schedule your appointment. This information will help us better understand why you are seeking therapy at this particular point in your life and will help guide us as we move forward.

The intake process includes a phone intake appointment and filling out of paperwork on-line. Once that process is done, we can schedule an in-person appointment. When appointments are available, the process generally takes 1-2 weeks and appointments can be scheduled within a week or two.

Erickson Counseling Services, Inc. is able to bill for counseling services through HealthPartners insurance, Blue Cross, Blue Shield insurance, Cigna insurance, Aetna insurance, Preferred One insurance and Medical Assistance. 

Beginning January 1, 2022, mental health care providers will be required by law to give uninsured and self-pay patients a good faith estimate of costs for services that they offer, when scheduling care or when the patient requests an estimate. This new requirement was finalized in regulations issued October 7, 2021. The regulations implement part of the “No Surprises Act,” enacted in December 2020 as part of a broad package of COVID- and spending-related legislation. The act aims to reduce the likelihood that patients may receive a “surprise” medical bill by requiring that providers inform patients of an expected charge for a service before the service is provided. See www.cms.gov/nosurprises for more information about your rights under this regulation.

Thank you.

* - denotes required field