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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?

Preferred Therapist for Individual Therapy

Preferred Therapist for Adolescent Therapy

Preferred Therapist for Child Therapy

Preferred Therapist for Family Therapy

Preferred Couples Therapist

How old is your child?

Please list all ages of children attending

Who is your insurance provider? (Let's confirm you are In-Network)

Do you have Secondary Insurance? If so, please list your secondary 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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©2022 Lakeshore Family Therapy, LLC created by Maggie Patel

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