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Dandelion Fields

CONNECT TO BEGIN

Please complete the following form to start the process to engage in therapy services. Upon completion of the form, you will be connected to the patient portal within 48 business hours. All information submitted on this form is confidential and follows HIPAA protocols to protect your privacy.

We are currently in network with United Health, UMR, Aetna, Traditional Medicaid, Lyra and Optum Behavioral Network.

Primary Concerns Required
Preferred Days to Meet with Therapist Required
Preferred Times to Meet with Therapist Required

Thanks for submitting!

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