*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. ​