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
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
- 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)
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.
