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RTC St Louis Park

5407 Excelsior Blvd, Suites A, B, D, & E
St Louis Park, MN 55416
612.787.2832

RTC Eagan

2600 Eagan Woods Dr. Suite 200,
Eagan, MN 55121
763.330.2023

Please fill out the form below and we will respond to you as soon as we possibly can. We appreciate your interest in our services.

"*" indicates required fields

What is your preferred contact method?*
Are you looking for in-person or Telehealth therapy, or both? (Please check all that apply.)*
Do you have a preferred office location?*
What type of therapy are you seeking?*
*Please note that we are not able to accept Medical Assistance Plans through United Healthcare or Medica. Additionally, we are unable to accept EAP benefits, or Medicare plans or supplements through any of the listed providers. If you do not see your insurance provider listed, we are likely not in network for your plan.
What brings you to the Relationship Therapy Center? (Please check all that apply.)*
If you selected "affair," "on the brink of divorce," or "crisis," we strongly recommend that you check out our Intensive Couples Counseling Program.
*If desired, you may request a particular therapist, or specify a preference for your therapist's gender/background/etc. Please note that requesting a therapist by name does not guarantee that they will be able to work with you at this time.
This field is for validation purposes and should be left unchanged.

If you experience any difficulties in using this form or haven’t heard back from us within 1 business day, please email us at relationshiptherapycenter@gmail.com

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