Patient Forms

Welcome to River Valley!  Intake forms provide important information to your provider. Please print the forms according to the age of the client and type of appointment. 
Bring the completed forms to your appointment.

Note* - Some forms require you to download them to your computer.  When you go to open the downloaded form, it will require you to choose a way to open the form.  Opening all forms with Word is your best option.  If you are having issues with opening the forms, please contact us at 952-746-7664.    

Adult Individual Therapy Appointments:

(Age 18+)

•    Intake Form Adult
•    Consent Form (Adult)
•    Demographic Form
•    WHO DAS

Child/Adolescent Individual Therapy Appointments:

(Ages 2-17)

•    Intake Form (Child/Adolescent)
•    Consent Form (Child/Adolescent)
•    Demographic Form
•    WHO DAS

Note* - Parents/guardians need to sign the consent form. 
Note* - Please note, if there is a joint custody situation, both parents need to sign the consent form.

Couples Therapy Appointments:

•    Intake Form (Adult)
•    Consent Form (Adult)
•    Demographic Form
•    WHO DAS

Note* - Both partners need to sign each section of the Adult Consent Form.
Note* - Both partners need to complete the Adult Intake Form.

Adult Medication Appointments:

•    Medication Appointment Form (Adult)

Child/Adolescent Medication Appointments:

•    Medication Appointment Form (Child/Adolescent)

Additional Forms:

•    ROI (Release of Information) Form
•    Notice of Privacy Practices Form