Thank you for choosing Northland Counseling Center, Inc! We have offices in International Falls, Grand Rapids, Hibbing & Aitkin. If you are in need of immediate assistance or feel you are having a mental health emergency, please call: 911, 988 or NCC Grand Rapids area Crisis at 218-256-2659 or go to your local emergency room.
In order to schedule you for an initial appointment we need to collect the following paperwork. Annually, thereafter; we will ask that you fill out the paperwork in order to update our records. If, at any time, you have questions on the paperwork or want to know why the information is needed please feel free to call 218-326-1274 and ask to speak to intake.
SMARTPHONE USERS:
If you are completing these documents on a smart phone, please use the ‘desktop‘ version otherwise forms may not submit, and it may require you to resubmit all of your information. We apologize for the inconvenience.
If you do not receive a call from a NCC staff member within 2 days of submitting your paperwork, please contact your local Northland Counseling Center, Inc. location to ensure they have received your paperwork. Please ensure you sign the forms and click submit. All of the below forms must be completed.
- Adult Registration Form
- Adult pre-Intake Questionnaire
- PHQ – 9
- GAIN-SS
- GAD-7
- WHODAS
- Provider Supervision Form
- Medicare Beneficiary Notice – If you have Medicare as an insurance plan, please review
- Release of Information
Release of Information
If you would like a family or friend involved in your mental health care, please fill out this form: Family & Friends Release of Information
You will need one form per person involved in your care. This form is optional.
In order to best help provide services please fill out a Release of Information for the following:
- Previous Mental Health Providers, if applicable
- Pharmacy Utilized
- Primary Health Care Clinic
If you fill out your paperwork and do not hear back from our intake department within 48 hours (this does not include weekends or holidays), please call 218-326-1274.
Telehealth
If you would like more information on our telehealth practices, click here.
