Records and Forms

Find for the form you need below

Records-Formsbhoffs@mac.com2026-03-20T09:55:46-05:00

Northern Pines Internal Service Related Forms

Referrals & Appointments

Safe Harbor RCS Referrals

Safe Harbor IRTS Referrals

Telehealth Appointment

All Other Referrals

Client Forms

Treatment Consent Form

Notice of Privacy Practices

Consent Form Summary

Financial Consent

Telehealth Consent

Client Complaint & Grievance Form

Client Complaint & Grievance Form

Client Remote Signature Form

Records

(Click in form) Yourself or 3rd partyClient Medical Records Request

Release of Information Form

CTSS School Surveys

CTSS Grade K-6 Student Survey

CTSS Grade 7-12 Student Survey

CTSS In-Home Family Survey

CTSS In-Home Client Survey

CTSS School Based Admin/Teachers

CTSS School Based Family Survey

CTSS Behavior Specialist/Behavior Interventionist

Northern Pines Mental Health Center

Northern Pines is an integrated system of services committed to individuals, families, and communities. We are dedicated to providing appropriate clinical mental health care along with preventative, educational, and supportive programs throughout Central Minnesota.

NAVIGATION

CONTACT

Northern Pines Mental Health Center
PO Box 367
Little Falls, MN 56345

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