RCTC - Demographic/Financial Information Demographic/Financial InformationThank you for your inquiry regarding Zumbro Valley Health Center Psychotherapy through RCTC. Psychotherapy services are typically covered through health insurance companies. To get started in services, please complete the following form call Zumbro Valley Health Center’s main office at 507-289-2089 and request intake.Name* First Last Date of Birth* MM slash DD slash YYYY Social Security # Address Street Address City State / Province / Region ZIP / Postal Code County of Residence Individuals Under 18 in Household Parent Name or Contact Person First Last Phone Number of Contact PersonInsurance Type & ID Number* Insurance Holder's Name* First Last Insurance Holder Date of Birth* MM slash DD slash YYYY Secondary Insurance Type & ID Number (if applicable) Secondary Insurance Holder's Name First Last Secondary Insurance Holder's Date of Birth MM slash DD slash YYYY Email CommentsThis field is for validation purposes and should be left unchanged.