Referrals

Client Intake Forms

Please Fax all forms to 612-781-2428

You will be assigned to a therapist who will contact you or your worker within 48 hours. The therapist will schedule an intake session.

Release/Exchange of Information
Authorized Consent to Treatment and Payment
Support Services Referral Form
Clients Rights & Responsibilities
FORM 23000: Minnesota Provider Notice of Privacy Practices

Questions?

If you would like more information about our fees or our practices, please contact us.