aamayberg@act-llc.us | (612) 444-6463
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Make an Appointment: aamayberg@act-llc.us | (612) 444-6463
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CONNECT WITH ME REQUEST AN APPOINTMENT
3209 W. 76th Street Suite 304, Edina, MN 55435
aamayberg@act-llc.us | (612) 444-6463

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Close menu
  • Home
  • About
  • Services
    • Individual Counseling
      • Anxiety
      • EMDR
      • Divorce Recovery
    • Couples Counseling
    • Discernment Counseling
    • Premarital Counseling
  • FAQ’s
    • Individual Counseling FAQ
    • Couples Counseling FAQs
    • Discernment Counseling FAQ
    • PREPARE/ENRICH© Premarital Counseling FAQ
    • PRIVACY FAQs
  • Fees, Payments & Insurance
  • Resources
  • Blog
  • Connect with me
(612) 444-6463

aamayberg@act-llc.us

Client Forms

Awakening Connections offers a paperless way to fill out your forms. After we’ve scheduled an appointment, you will be sent an email invitation to a client portal where you can fill out and e-sign your forms online and upload them back to me. If you would prefer you can print the forms and bring them with you to your first appointment.

  • Client Intake Form
  • HIPAA Notice of Privacy Practices
  • Limits of Confidentiality

CONNECT WITH ME REQUEST AN APPOINTMENT

Amy-Ann Mayberg,
MA, LMFT

3209 W. 76th Street Suite 304
Edina, MN 55435

(612) 444-6463
aamayberg@act-llc.us

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

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Awakening Connections Therapy
aamayberg@act-llc.us | (612) 444-6463

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