Forms - Lighthouse

LCFS 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 form from the client’s parent or legal guardian to submit along with the referral form. If you have any questions, please feel free to contact us at (320) 983-2335.

Lighthouse Child & Family Services Referral Form – printable
Online Lighthouse Child & Family Services Referral Form
Release of Information

Intake Packets

Adult Intake Packet
Child Intake Packet

LCFS Forms

Adult Information Form
Child Information Form
Client Bill of Rights & Grievance Procedure
Client Consent Form
Office and Financial Policy Agreement
PHQ-9/GAD-7 – Adult
PHQ-A/GAD-7 – Child/Adolescent
Notice of Privacy Practices
Release of Information

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.