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

Client Intake Forms

Please call one of our convenient office locations to set up an appointment before filling out paperwork. If you have an active email address, intake paperwork can be filled out electronically through our secure online system. Please contact an Office Manager for more information.

If you are unable to complete the intake forms ahead of time, please arrive 15-20 minutes early. Forms will be available to you when you arrive at the clinic. If you are coming in as a couple, note that each of you are to fill out your own set of forms.

If you prefer to print paperwork and complete it before your appointment, click on a form title to open a Microsoft Word document of that form. You may complete the form by word processing or by handwriting in the requested information. Please bring these to your first session.

Please note: All forms are in Microsoft Word 97-2003 format. If you do not have access to Microsoft Word, you can download a free version of Open Office by clicking HERE.

Please bring the Intake Paperwork, Consent for Treatment, and Release for Primary Care Physician forms to your first appointment.

I think you have to try and fail because failure  gets you closer to what you’re good at. – Louis C.K.

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

ALL PATIENTS

CHILD/ADOLESCENT PATIENTS

FOR YOUR REFERENCE

FOR ADD/ADHD PATIENTS

Insured Information & Consent for Treatment Consent for Treatment (Download File)

Client/Insured (Download File)

Physician Release
Download File (word processing version)
Download File  (handwritten version)

Protected Health Information (PHI) Release
Download File (word processing version)
Download File  (handwritten version)

Diagnostic Assessment Download File

HIPPA Privacy Practices

Psychological Services, Policies and Procedures

click here