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Sage Leaf Wellness Waitlist
By completing this form our scheduling assistant will be alerted to add you to the Sage Leaf Wellness Waitlist. You will receive periodic emails to let you know who has openings.
We have current openings now, so no need to wait! Hop back to our
scheduling portal
to set something up today.
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* Indicates required question
Email
*
Your email
First & Last Name
*
Your answer
Clients Age
*
Your answer
phone number
*
Your answer
Service Requested (select all that apply)
*
Individual Adult Counseling (age 18+)
Individual Adolescent Counseling (age 13-18)
Couples Counseling
EMDR (Eye Movement Desensitization & Reprocessing) / Trauma Treatment
Individual Elder Counseling (age 65+)
Addiction Related Counseling (sex, gambling, substances, shopping, food, etc)
First Responder Specialist
Other:
Required
Location
*
St Paul - In Person Therapy
Telehealth - Minnesota
Telehealth - Florida
Telehealth - Iowa
Other:
Required
Times Available for Appointments (select all that apply)
*
Weekdays during normal business hours (9am-5pm)
Evenings (4pm or later)
Weekday early morning (before 9am)
Weekends (Saturday/Sunday)
Specific Day of the week
Other:
Required
Insurance Plan You Hold
*
BCBS (Blue Cross/Blue Shield) (commercial policy)
BCBS (state of MN PMAP)
Ucare (Commercial policy)
Ucare (state of MN PMAP)
Optum/Medica/UnitedHealthcare/UMR
HealthPartners (commercial policy)
HealthPartners (state of MN PMAP)
Aetna
PreferredOne
Hennepin Health
Medical Assistance
Self Pay/No Insurance
Other:
Required
Provider Preference
*
Britni Kelley
Ben Mushel
Morgan Boeltl
Any Open Provider
Other:
Required
How did you hear about us?
*
Google Search
EMDRIA Website
Friend/Family
Mutual Client
Another Therapist
Primary Care Provider
School Counselor
Psychology Today
Other:
Required
Send me a copy of my responses.
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