Appointments, Referrals & Intake Forms
Making an Appointment or Referral
We have amazing referral staff who are ready to take your call and assist with getting services started and scheduling an appointment. Please call them at the extension listed below:
(320) 629-7600 Ext. 7606
Referral staff may have you complete a referral form which can be found below. Please fax completed forms to 651-925-0071.
- Outpatient & In-Home Family Based Services Referral Form
- Day Treatment Referral Form
- School Based Mental Health Services Referral Form
- Deaf and Hard of Hearing Services Referral Form
If you are interested in making a referral for a program or service that is not listed above, we encourage you to call our referral team.
Intake Forms
Outpatient Services and In-Home Family Based Services
Below are links to common intake forms we ask clients to complete prior to the start of services. If you are able to, please print off and complete the forms relevant to your situation. If you do not have access to a printer, please plan to arrive 15-20 minutes early to your first appointment and our administrative staff will be happy to provide you with the appropriate forms.
- Billing Release - Completed by all clients (for parent/guardian of client under 18 years old). *If you are a county worker, please complete the Billing Release prior to scheduling an appointment for your client.
- Adult History Questionnaire - Completed by adult client who is receiving services for themselves
- Child/Adolescent History Questionnaire - Completed by parent/guardian for their child under 18 years old
- Consent for Release of Information - Completed by all clients (or parent/guardian of client under 18 years old). *If you are a county worker, please complete the Consent for Release of Information prior to scheduling an appointment for your client.
- Notice of Privacy Practice (Form 23000) - Information for client's personal records
- Client Bill of Rights
- Office and Financial Policy Agreement
At this time, only intake forms for our Outpatient services and In-Home Family Based Services are accessible online. Forms for other TSA programs and services will be discussed and available to you at your first appointment.
