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:
Child/Adolescent Individual Therapy Appointments:
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:
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:
Child/Adolescent Medication Appointments:
- Client Permission and Acknowledgement Form (Re-Consent)
- Credit Card Payment and Authorization Form
- ROI (Release of Information) Form - Therapy
- ROI (Release of Information Form) - Medication Management
- Controlled Substance Agreement
- Notice of Privacy Practices Form
- River Valley Pet Policy
- Telemedicine Consent Form
- Psychological Testing Billing Agreement
- Psychological Evaluation with Testing Form