MAKE A PAYMENT

Payment Amount *

Cardholder Email *

Cardholder Phone *

Cardholder Address *

Address Line 1

Address Line 2

City

State

Zip Code

DOB *

Is the cardholder the same as the client? *

Yes
No

Client Name *

First

Last

Client DOB *

Client Email

Client Address

Address Line 1

Address Line 2

City

State

Zip Code

Client Phone

NOTES (DATE OF SERVICE, CLIENT RELATIONSHIP, ETC)

Total

$ 0.00

Stripe Credit Card *

Card

Name on Card

QUESTIONS

If you have any questions related to your account please call, 218-301-3164

INSURANCES ACCEPTED

Carefree Counseling’s Clinicians are In-Network with a variety of providers including:

BCBS – Blue Cross Blue Shield
MHCP – MA
Medical Assistance
Medicare
PreferredOne
UCare
HealthPartners
HealthPartners-Commercial
Cigna
Aetna
Hennepin Health
United Health/Medica

Additionally, Out of Network & Out of Pocket options are available.