*Please contact a Northland Health Centers Team Member before completing the following forms, to ensure you are filling out the correct forms and including the correct necessary documentation.
Adult Behavioral Health Forms:
Demographic/Intake Form Informed Consent Form (Telehealth Only) Informed Consent Form New Patient Adult PHQ-9 Sliding Fee Scale Application Sliding Fee Scale Waiver Patient Responsibility Notice Release of Information Please Email Sliding Fee Scale Application, Sliding Fee Scale Waiver, Release of Information, and Informed Consent completed forms to BH@northlandchc.org |