Informed Consent Form

 Intake Form

Adult Information Form

Child Intake Form


Consent to Consult

Private Pay

Telemedicine Consent Form

Release of Information

Electronic Communication and Billing Communication

Adobe PDF Documents can be downloaded and completed on your computer then printed. 

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© 2002 by Counseling and Mediation Solutions LLC

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Feel free to complete our contact form or call for an appointment today 651-307-4993  Thank you!
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Counseling & Mediation Solutions has MOVED to a NEW location:
The BRICK HOUSE - 407 West Broadway, Forest Lake, MN 55025