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Crescent Moon Counseling, LLC

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Please fill out the form below

to request an appointment.

Who is this request for? * Required

Myself

Someone Else

First Name

Last Name

Email

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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Insurance Plans We Accept

Crescent Moon Counseling, LLC

125 East 3rd Street

Suite #1

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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