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Directory Results for Ina Lasmane, LLC Anoka Location: 14451 Highway 7, Suite 2A Minnetonka, MN 55345 Phone: (612) 5598704, Fax: (612) 2798205 540 Greenhaven Rd, Suite# 206 Anoka, MN 55303 Phone: (612) 5598704, Fax: (612) 2798205 OFFICE POLICIES/ EAP ADDENDUM In to Ina Lasmane, LLC Phone: (612) 5598704, Fax: (612) 2798205 CLIENT PSYCHOTHERAPY ASSESSMENT CHECKLIST Name: Gender DOB: Age: Date: Relationship Status: Single Married Divorced Separated Cohabitating Other I live with: Children: No Yes (If

Ina Lasmane, LLC Anoka Location: 14451 Highway 7, Suite 2A Minnetonka, MN 55345 Phone: (612) 5598704, Fax: (612) 2798205 540 Greenhaven Rd, Suite# 206 Anoka, MN 55303 Phone: (612) 5598704, Fax: (612) 2798205 OFFICE POLICIES/ EAP ADDENDUM In
Ina Lasmane, LLC Phone: (612) 5598704, Fax: (612) 2798205 CLIENT PSYCHOTHERAPY ASSESSMENT CHECKLIST Name: Gender DOB: Age: Date: Relationship Status: Single Married Divorced Separated Cohabitating Other I live with: Children: No Yes (If