Register

Registration is only required if you do not have a username. Please check your spam & junk mail folders to ensure you have not already received an email with a username and password. If you already have a username log in here

Each account must have a unique email address associated with it. Please contact us if you need multiple accounts with the same email address (i.e. related family members).

Client Information

/ Middle Initial

( optional )
 

( MM-DD-YYYY )


( optional )
( optional )





( for Text Message Reminders )

Bill To Contact

Emergency Contact

First Name
Last Name
Phone
Mobile
Relation
Email
Street Address
City
State
ZIP Code

Log in Details




Between 8 and 40 letters and numbers

Challenge Questions

( These will be used to retrieve your password. Answers must be between 4 and 30 characters, cannot contain any spaces. )




( If you feel you must write down your questions in order to remember them, make sure to keep it in a safe place. )

Terms and Policy

Counseling Agreement

- I have received information about Dr. Monica Landolt White, LMFT, including a description of my client rights.

- I authorize Dr. Monica Landolt White, LMFT to provide treatment to myself/my child and understand that I can revoke this consent at any time, in writing. 

- I understand that I am financially responsible for all charges.

- I agree to keep Dr. Monica Landolt White, LMFT updated on any changes to my personal information (phone number, address etc.).

- I agree to communicate via email with Dr. Monica Landolt White, LMFT and I understand that confidentiality cannot be guaranteed when using email.

- I understand and give permission for Dr. Monica Landolt White, LMFT to consult with other Mental Health Professionals about my case. In order to maintain confidentiality, Dr. Monica Landolt White, LMFT will take precautions to keep any identifying information private and confidential (full name, place of work, etc.). 

- I understand that Dr. Monica Landolt White, LMFT is not a crisis resource. If I am in crisis I understand I can call 911 or the Crisis Hotline at (612) 379-6363.

By signing below, you are agreeing to the above described policies and indicate your consent for treatment. 

( Type Full Name )
( Full Name )