Appointments and Intake Forms

 

 

Appointments can be made Monday through Friday

 9:00am – 5:30pm (every ninety minutes)

by calling 218-372-3801

Monarch Counseling Service office is located at

72351 Pine River Road, Willow River, MN  55795

Click for Directions

Initial or diagnostic appointments are typically 90 minutes in length with follow-up appointments at 50 minutes length.

Your initial appointment will generally be 75 -90 minutes due to the initial assessment, treatment planning and diagnostic assessments.  Once your initial appointment is set please download and fill out the intake forms listed below and please read and fill out the Informed Consent for Supervision document, to bring to the first appointment.

ADULTS

1. Intake Questionnaire

2. Informed consent  & Notice of Privacy Practices

3. Patient Health Questionnaire

4. WHODAS12itemsSELF

5. ACE

6. My Private Practice Social Media and Electronic Communication Policy

As I work toward a license as an Independent Clinical Social Worker I am required to participate in weekly supervision sessions.  The following form is to explain this process and acquire your informed consent.

7. Informed Consent for supervision

CHILDREN

If your child(ren) are participating in individual or family therapy these forms will need to be completed for each child. Please note: the State of Minnesota requires licensed social workers to complete a diagnostic assessment and initial treatment plan at the first visit. Completing these forms will speed up the process. Also note the ages appropriate to your child. Children 11-17 have two questionnaires to fill out (Symptom  check and Strengths and Difficulties) 

Child intake

Notice of Privacy Practices

Part 1 Child DA

Symptom check list ages 6-17 – Parent:Guardian

Symptom check list ages 11-17 Self-report

Consent to Provide Treatment to Minor Children

Strengths and Difficulties ages 4-10 PARENT

Strengths and Difficulties ages 11-17 – CHILD

Strengths and Difficulties ages 11-17 PARENT (1)

COUPLES (each person fill out each form)

Couples-Counseling-Initial-Intake-Form

Patient Health Questionnaire

Informed consent  

Notice of Privacy Practices

My Private Practice Social Media and Electronic Communication Policy

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