Maple Grove Counseling Center
13700 83rd Way, Suite 205
Maple Grove, Minnesota 55369
Phone: 763-494-8699  Fax: 763-494-8797

New Client Information

Welcome to Maple Grove Counseling Center's Website!

To become a new client, please call our office at 763-494-8699.  Appointments are scheduled with you directly so that we can match your needs with our best resources. Confidential voicemails can be left at any time.  We look forward to being your resource for Finding Calm in Stressful Times.

After scheduling your initial appointment, please print and complete each of the forms listed below.
Please bring the completed forms and your Insurance Card with you to your first appointment.
Thank you.

There are four forms listed below. Each one uses a program titled Adobe Reader. 
When you Select "view as PDF file", a new window opens, and allows you to see the form. 
In the top left corner, you will see an icon that shows a printer. (See image to the right.)
When you select the icon, it will allow you to print the form on your printer.

 

PLEASE CLOSE EACH FORM'S WINDOW PRIOR TO SELECTING THE NEXT FORM.
 
Client Data Form  view as PDF file
Medical Benefits Information and Authorization Form  view as PDF file
Client Rights and Responsibilities Form  view as PDF file
Health Information Consent Form (HIPAA)  view as PDF file
     (Information and Signature form for Health Information Consent)

Select, Download and Print all 3 forms, select view as all PDF files

 

 

 


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