Forms

Lighthouse Child & Family Services Referral Forms

If you are a social worker or other professional making a referral for general therapeutic services, please secure a signed release of information from the parent or legal guardian and fax us the completed referral form to initiate the intake process. If you have any questions, please feel free to contact us at (320) 983-2335.

LCFS Referral Form Lighthouse Child & Family Services Referral Form

LCFS Referral Form Lighthouse Child & Family Services Referral Form – ARMHS/CSP

LCFS Referral Form School Referral Form

Important – Email correspondence is not secure.  Given HIPAA privacy laws we ask that you please print the referral form and fax it to our offices at: (651) 342-8029. Thank You.

Release of Information

Release Of Information Release of Information

Intake Packets

LCFS Referral Form Outpatient Adult Intake Packet

LCFS Referral Form ARMHS/CSP Intake Packet

LCFS Referral Form Outpatient DC03 (Child Under Age 5) Intake Packet

LCFS Referral Form Outpatient Child (Ages 5 – 17) Intake Packet

LCFS Referral Form School Linked Mental Health Intake Packet

Intake Forms

LCFS Referral Form Privacy Policy – All Clients

LCFS Referral Form Health Care Directive

LCFS Referral Form Consent Form – All Clients other than SLMH

LCFS Referral Form Client Email/Texting Informed Consent

LCFS Referral Form Treatment Contract – All Clients other than SLMH

LCFS Referral Form Adult Client Information Form

LCFS Referral Form Child/Adolescent Information Form

LCFS Referral Form WHODAS – Adults Only

LCFS Referral Form PHQ-9/GAD-7 – Adults Only

LCFS Referral Form PHQ-A/GAD-7 – Child/Adolescent

LCFS Referral Form SDQ – Ages 4-10 – Parents of Clients in this Age Group

LCFS Referral Form SDQ – Ages 11-17 Parent Form – Parents to Complete

LCFS Referral Form SDQ – Ages 11-17 Client Form – Client to Complete

LCFS Referral Form Testifying Policy – All Clients other than SLMH

LCFS Referral Form SLMH Consent Form – SLMH Clients Only

LCFS Referral Form SLMH Treatment Contract – SLMH Clients Only

LCFS Referral Form SLMH Financial Responsibility Form

In house Skills Referral Form Waiver and Permission to Transport Child