Name*Email* Phone*Where in the world are you?*What service(s) are you looking for?* Therapy (must be in Minnesota) Therapeutic Coaching Akashic Healing Dating Coaching Professional Consultation or Mentoring Not sure How will you be paying for this service?* Health Insurance Private Pay Who is your insurance company?AetnaCignaPreferredOneHealthPartnersMedicare/Medicaid/MN CareOtherPlease Note — Most HealthPartners plans treat Jane as out of network. If you have out-of-network benefits, you will receive the reduced HealthPartners rate until you have met your deductible. Plans with no out-of-network benefits do not offer any coverage, nor will you receive the reduced HealthPartners rate. FSA or HSA plans may be used. Please note that Jane is not covered by Medicare, Medicaid or MNCare plans. Services are available at the full rate and you will receive a Superbill to submit to your insurance plan for reimbursement. FSA and HSA plans may be used.Services will be out-of-network for your insurance. Jane will collect the full fee from you at the time of your session and submit paperwork to your insurance on your behalf. If you have out-of-network benefits your insurer will reimburse you directly according to your plan. FSA and HSA plans may be used. Do you still wish to continue?YesNoPlease share a few sentences about what is bringing you to Jane at this time.*What do you hope will be different in your life after working with Jane?*How did you hear about Jane?*We wish you all the best with your therapy journey.PhoneThis field is for validation purposes and should be left unchanged.