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:
if the page is blue, scroll to the bottom and click on desktop version. otherwise, the page will not submit.
- Adult Pre-Intake Questionnaire
- Adult Registration Form
- Provider Supervision Form
- Medicare Notice – please complete if you have Medicare as an insurance plan
- Release of Information – Agencies & Providers
Please complete the form below and if you would like to learn more about why this information is important click here.