Contact Form

Complete this contact form if you are interested in any of our services. Someone will reach out to you to follow up with your inquiry.

Embrace & Empower Mental Health PLLC

Phone:

612-315-0353

Email:

info@embraceempowermh.com

First Name

Last Name

Date of Birth * required

Phone

What kind of therapy is being sought? * Required

Individual therapy

Couples therapy

Family therapy

Group therapy

ADHD screening assessment

Other

Preferred clinician

Who would be receiving care? * Required

My partner and I

My child/dependent

My family

Someone else

Referral source

Additional information

*For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

*By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.

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Embrace & Empower

Mental Health PLLC

Phone: (612) 315-0353

Fax: (612) 234-4485

Email: info@EmbraceEmpowerMH.com

508 3rd St SE

Osseo, MN 55369

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Disclaimer: The information on this website is for general information purposes only. Nothing on this site should be taken as healthcare advice for any individual case or situation. This information is not intended to create, and receipt or viewing does not constitute, a healthcare professional-patient relationship. We do our best to keep information accurate and up to date, however mistakes do happen, and we cannot make guarantees regarding the accuracy of our information. We are not liable for any information on this website or your reliance upon it.