Northland Community Health Centers
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*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. ​
Psychiatric Patient Forms:
Adult Intake Form

Child Intake Form

​Release of Information Form-for Psychiatric NP

Informed Consent

Demographic/Intake Form

​
Please Email completed forms to 
​BH@northlandchc.org

*For appointments with our Psychiatric Nurse, all paperwork must be complete prior to the appointment. If you arrive 15 minutes or later or do not have the paperwork completed, your appointment will be rescheduled. ​
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  • Home
    • About Us
    • Contact Us
    • Donate
  • Our Team
    • Executive Staff
    • Clinical Team
    • Dental Team
    • Mental Health Team
  • Locations
    • Bismarck
    • Bowbells
    • Central Office
    • McClusky
    • Minot Behavioral Health
    • Minot Dental
    • Minot Medical
    • Ray
    • Rolette
    • Rolette Dental
    • St. John
    • Turtle Lake
    • Turtle Lake Dental
  • SERVICES
    • Dental
    • Medical
    • Mental Health
    • MAT Program
    • Outreach & Enrollment
    • Patient Guide >
      • Becoming a Patient
      • Preparing For Your Appointment
      • Your Medical Information
      • Billing Information
    • Healthier You Challenge >
      • Healthier You Points
      • Healthier You Weekly Winners
    • Resources
  • Patient Forms
    • All Patient Forms
    • Dental Forms
    • Adult BH Forms
    • Child & Adolescent BH Forms
    • Psychiatric Patient Forms
  • Careers
    • Career Opportunities
    • Application FAQ's
    • Student Loan Repayment
    • Discover North Dakota
  • EHS Dashboard
  • NHC Store