Client Intake Forms

Please call one of our convenient office locations to be matched with a provider who fits what you are looking for or you can request a specific provider if you have one in mind. You will be asked to complete paperwork prior to scheduling. Intake paperwork can be filled out electronically through our secure online system as long as you have an active email address.

If you do not have an active email address, you can request paperwork to be mailed or faxed to you. You can also print paperwork by downloading each form listed below. This will open a PDF document of that form. At minimum, you will need to complete the Intake Paperwork, Consent for Treatment, and Release for Primary Care Physician forms. You may complete the form by handwriting in the requested information. Please mail or fax the completed paperwork to your respective office location. Please contact an Office Manager with any questions by calling your respective location.

You are also provided access to our HIPPA Privacy Practices and Information About Our Psychological Services, Policies, and Procedures by downloading them from the list below.

Please note: All forms are in PDF format. If you do not have access to Adobe, you can download a free version by clicking HERE.

Call for an appointment at one of our four convenient locations:

Coon Rapids | 763-780-1520
Cambridge | 763-689-9407
Chisago City | 651-257-2733
St. Louis Park | 763-780-1520




Client Insured Information (Download File)

Consent for Treatment (Download File) 

Physician Release (Download File)

Protected Health Information (PHI) Release (Download File)

Parent Diagnostic Assessment (Download File)

HIPPA Privacy Practices (Download File)

Psychological Services, Policies and Procedures (Download File)

A strategic alliance for exceptional mental health care