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  • Clinicians
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Pre-Schedule Information Form

Step 1 of 4

25%
  • MM slash DD slash YYYY
  • The Responsible Party is the name of the person who is legally responsible for the client and payment of services that are not covered by insurance.
    We do not do phone reminders; we use an automated system that, by default, will alert you one day in advance of your appointment based on what you check here.
  • Let's get your insurance information

  • Common insurance types are: Blue Cross/Blue Shield, Medica, UHC, AETNA, CIGNA, HelathPartners, Ucare, SelectCare, PreferredOne. If you wish to use the CounselingCare program, simply type in "CounselingCare"
    An EAP is different than your regular insurance as it often cover the full cost of your time with a therapist. Sometimes people refer to these as "free sessions." Often times, UBH/Medica policies have EAP sessions available. Check with your insurance company or employer for more details.
  • It is usually the longest number you have on your insurance card. For some insurances, it is still your social security number
  • This is usually the smaller of the numbers on your insurance card
  • MM slash DD slash YYYY
  • Typically this number is on the back of your insurance card. It may be called Provider Support, Customer Support, or Authorization Line
  • Common insurance types are: Blue Cross/Blue Shield, Medica, UHC, AETNA, CIGNA, HelathPartners, Ucare, SelectCare, PreferredOne.
  • It is usually the longest number you have on your insurance card. For some insurances, it is still your social security number
  • This is usually the smaller of the numbers on your insurance card
  • MM slash DD slash YYYY
  • Typically this number is on the back of your insurance card. It may be called Provider Support, Customer Support, or Authorization Line
  • Thanks, now tell me when you are available to come in.

    Saturday openings depend on clinician availability
  • Last Step!

  • When you are ready, go ahead and hit the submit button. A confirmation email will arrive shortly thereafter.

Contact Us

  • Phone:(763) 515-4563Opens in your application
  • Toll Free:(888) 863-6360Opens in your application
  • Email:questions@helpwithsolutions.comOpens in your application

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