Forms

Please complete the appropriate forms before your appointment. Each link opens securely in Hushmail. Questions? Call 612.374.2400.

HIPAA Compliant

Parent Child Relationship Repair Forms

  1. APS Parent-Child Relationship Repair (PCRR) Agreement
  2. Screening for Parent-Child Relationship Repair (PCRR) Services
  3. Safe Harbor Agreement
  4. HIPAA Compliant Authorization for the Release of Client/Patient Information
  5. Secure Portal Access Form

Family Therapy Forms

  1. APS Family Agreement
  2. Safe Harbor Agreement
  3. Secure Portal Access Form

Individual Therapy/EAP/Couples Therapy Form

  1. Consent Form for Psychological Services
  2. Secure Portal Access Form

Co-Parenting Coaching

  1. Co-Parenting Coaching Agreement
  2. Secure Portal Access Form

Parenting Consultant

  1. APS Parenting Consulting Fee Agreement
  2. Parenting Consulting Information Form
  3. Secure Portal Access Form

Child Inclusive Mediation

  1. Child Consultant Fee Agreement
  2. CIM Safe Harbor Agreement
  3. Secure Portal Access Form

Consultation for Family Building Medical Services

  1. APS Infertility Consultation Consent and Fee Agreement
  2. HIPAA Compliant Authorization for the Release of Client/Patient Information
  3. Secure Portal Access Form

Neuropsychological Assessments

  1. Consent Form for Psychological Services
  2. Secure Portal Access Form

General Forms

  1. Secure Portal Access Form
  2. HIPAA Compliant Authorization for the Release of Client/Patient Information
  3. Payment Remittance Form