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.
- Lighthouse Child & Family Services Referral Form – printable
- Online Lighthouse Child & Family Services Referral Form
Release of Information
Intake Packets
Intake Forms
- Privacy Policy – All Clients
- Consent Form
- Adult Client Information Form
- Child/Adolescent Information Form
- PHQ-9/GAD-7 – Adults Only
- PHQ-A/GAD-7 – Child/Adolescent
- SDQ – Ages 4-10 – Parents of Clients in this Age Group
- SDQ – Ages 11-17 Parent Form – Parents to Complete
- SDQ – Ages 11-17 Client Form – Client to Complete
- Bill of Rights
- Office and Financial Policies
Telehealth Forms
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.
