Monica Geers Dahl

Grow Verified

$250

Relationship to client

Client's legal first name

Client's legal last name

Client's email

Client's mobile phone number

Client's date of birth (mm/dd/yyyy)

Client's sex listed on insurance

Provider does not accept insurance

Insurance

Cash, Out-of-pocket

Credit, Debit, or HSA Card

PCI Encryption

Residential address

This should be in the state from which the client will receive care

City

State

Zip code

I have reviewed and accept Grow Therapy's HIPAA Notice of Privacy Practices, Informed Consent, Practice Policies, Terms of Service, and Website Privacy Policy and consent to receive text messages and other communications from Grow about my account and Grow’s services.

It’s free to cancel your appointment up to 24 hours for any reason.