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Preparing for the Intake
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If you would like to save time at the intake appointment, please print and complete the following materials and then bring them with you. You may also choose to complete these when you arrive. 

 

If the potential client is an ADULT, use the following links (PDF files):

Adult Intake Information form

Consent form

HIPAA Form

Fee Agreement

 

If the potential client is a CHILD, use the following links:

Child Intake Information form

Consent form

HIPAA Form

Fee Agreement

 

Authorization to Release Confidential Clinical Records and Exchange Protected Health Information

 

PSYCHOLOGICAL SERVICES CENTER
210 Montgomery Hall

P.O. Box 7108

Grand Forks, North Dakota

58202-7108

701.777.3691