YOUR FIRST SESSION
A completed intake form is needed prior to the start of your first session. If you have a printer available, please print and fill out an intake form and bring it with you to your first session. Just check in with the office staff 10 minutes before the appointment. If you will be filling out the intake form in our office, please arrive 45 minutes before the session.
Email us at firstname.lastname@example.org or call us at (701) 772-1588 if you have any questions.
- Adult Intake Form – Fill Out Online
- Dr. Tillman’s Child and Adolescent Intake Form – Fill Out Online
- Child and Adolescent Intake Form (except for Dr. Tillman)
Feel free to download and print these forms:
- Adult Intake Form – Download & Print
- Dr. Tillman’s Child and Adolescent Intake Form – Download & Print
RELEASE OF INFORMATION
If you are working with another professional on issues related to the reasons for seeking services at Family Institute, a signed authorization for release of information (ROI) will be needed. Below are the ROI forms for our two locations.
SCREENING AND TRACKING FORMS
Psychological screening forms are intended to be educational and informational. They may help increase your awareness of particular experiences or of particular forms of psychological distress in your everyday life.
PLEASE NOTE: These forms are NOT for diagnosing any type of mental health or general health condition. In terms or your work with the Family Institute, the use of these forms is optional.
- ADULT ADHD SCREENING FORM: WMH-CICI Adult ADHD Self-Report Scale
- ADULT ALCOHOL SCREENING FORM: The MAST Test