PILOT Telehealth Forms

Combined Consent Form

The combined consent form includes all of the following:

Privacy Practice

Treatment Consent

Telehealth Consent

Summary of Consent Form

Release of Information (with dropdowns)

These Forms are in PDF format you will need Adobe Reader to view them

 

You can get Adobe Reader Here

MN Crisis Text Line
MNSure
Minnesota Farm & Rural Helpline

Northern Pines Mission

 

Northern Pines is an integrated system of services committed to individuals, families and communities. We are dedicated to providing appropriate clinical mental health care along with preventative, educational and supportive programs throughout Central Minnesota.