The following forms can be downloaded and filled out prior to your first visit at IPC if you would like to complete them before coming to our office. The required forms are the Intake Data Sheet, the Confidentiality Notice, and Informed Consent for Therapy, and the Informed Consent for Payment of Services. The HIPPA Notice is simply the Federal guidelines on confidentiality and is for your review.


Custody Issues & Therapy for Minors: It is the policy of IPC that for minor children, where legal custody is split (joint) between parents or guardians who are no longer married or cohabiting, we need authorization and signature from both parents on our Informed Consent for Therapy & Payment and Confidentiality Notice prior to the child being seen. These forms can be downloaded here, completed, and brought to the first session.


Downloadable Forms: (click to download PDF of any form listed below)

Counseling, Therapy, Psychiatry

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General and Specialized Counseling Services | Sitemap | 7236 Forestview Lane N. Maple Grove, MN 55369 | Phone: (763) 416-4167