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Fill out a New Client Form below and we will get back to you within 2-3 days.

New Client Form

First Name

Last Name

Email

Phone

What type of therapy are you interested in?

How old is your child?

Preferred Therapist

Preferred Family Therapist

Please list all ages of children attending

Preferred Couples Therapist

Preffered Chemical Health Assessor

Who is your insurance provider?

Message

How would you like us to reach you?

Thank you for submitting, we will be in touch with you in 2 to 3 days. 

Fax: (651) 560- 8469

Info@lakeshorefamilytherapy.com

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3701 Shoreline Drive
Suite 102 & 202
Wayzata, MN 55391, USA

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