Thank you for choosing Northland Counseling Center, Inc! Please complete the below form as part of our intake process or for our annual update. Any missing information may cause a delay in services. Along with this form please ensure you are also filling out these additional forms:
- Adult Health Questionnaire
- Provider Supervision Form
- Medicare Beneficiary Notice– If you have Medicare as an insurance plan, please review
- Missing Appointment Policy
if the page is blue, scroll to the bottom and click on desktop version. otherwise, the page will not submit.