Request Appointment | Crescent Moon Counse

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Please fill out the form below

to be added to the waitlist.

Who is this request for? * Required

Myself

Someone Else

First Name

Last Name

Phone Number

Which service(s) are you intersted in? * Required

Adolescent Therapy

Adult Therapy

Telehealth

Talk Therapy

Art Therapy

Walk N'Talk Therapy

Eco-Art Therapy

Other

What days of the week are you available for therapy? * Required

Monday

Tuesday

Wendsday

Thursday

Friday

Saturday

What time of day works best for your schedule? * Required

Morning

Afternoon

Evening

How will you pay for therapy? * Required

Health Partners Insurance

Medica

United Health Care

BCBS of Minnesota Insurance

Self Pay

St.Croix County CCS

What are your Goals for therapy?

Questions or Comments:

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Thanks for submitting!

You have been added to the waitlist at this time. If a spot becomes available, you will be contacted as soon as possible.

If you are in immediate crisis

Please call the Suicide & Crisis Lifeline by dialing 988, or call 911.

Crescent Moon Counseling, LLC is not available for crisis or emergencies through this message system. Thank you.

Insurance Plans We Accept

Crescent Moon Counseling, LLC

125 East 3rd Street

Suite #6

New Richmond, WI 54017

(715) 952-9072

support@crescentmooncounselingllc.com

YOU BELONG HERE

P.O. Box 188

Amery, WI 54001

(888) 715-2506

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