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)

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You can get Adobe Reader Here

MN Crisis Text Line
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.