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
Please complete the form below and if you would like to learn more about why this information is important click here.