Appointment Request
This form is for NEW clients only. If you are a returning client, please contact us directly at 612-927-7335 x 110 or mpach@mtolivetcounseling.org. Thank you!
Personal Information:
Gender of Legal Record:*
Contact Information
Address
Provider:
Provider Will Be Assigned
Your Information is confidential. However, if you are uncomfortable fully describing your reasons for seeking services, please provide enough information so our staff can match you with the appropriate provider.
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Appointment Request

This form is for NEW clients only. If you are a returning client, please contact us directly at 612-927-7335 x 110 or mpach@mtolivetcounseling.org. Thank you!
Personal Information
Contact Information
Phone

Address

Provider:
Please explain the reason you are seeking help at this time:
Submit
Cancel
Clinic Address
1804 W 50th St
Minneapolis, 55419-1001
Billing Address
1804 W 50th St
Minneapolis, MN 55419-1001
Clinic Phone No.
(612) 927-7335

Billing Phone No.
(612) 927-7335
Business Hours
Telehealth and in-person services available Monday - Friday. Daytime and evening hours available.