*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