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  • 866.938.4159
  • Providers
  • Locations
    • Iowa
    • Minnesota
    • Missouri
    • North Dakota
    • Wisconsin
  • Services
    • Therapy
    • Psychiatry
    • Substance Use Treatment
    • Psychological Testing
    • Dialectical Behavior Therapy (DBT)
    • Telehealth
    • View All Services
  • Specialties
    • ADHD
    • Anger Issues
    • Anxiety
    • Autism
    • Bipolar Disorder
    • Depression
    • Insomnia
    • LGBTQIA+ Affirming
    • Stress Management
    • Substance Use
    • Suicidal Thoughts
    • Work Issues
    • View All Specialties
  • Referral Partners
    • Make A Referral
    • Referral Forms
  • Resources
    • About Us
    • Blog
    • Everyday Therapy Podcast
    • Self-Help Tips
    • Newsroom
    • Pay My Bill
  • Employment
    • Careers
    • Internships
    • Clinical Continuing Education
    • Employee Links
  • Find a Location
  • 866.938.4159

Additional Patient Forms

Hannah Hippe2025-11-05T08:59:56-06:00

Additional Patient Forms

If you’re having problems accessing any forms, please hit the CTRL + F5 keys on your keyboard. If you have further questions, please call your clinic.

  • General Forms
  • Release of Information
  • Service Specific Forms

General Forms

Online Forms

    • Medical Record Amendment Request Form
    • UBH Wellness Assessment Adult
    • UBH Wellness Assessment Youth
    • UBH Consent Form

PDF Forms

    • Medical Record Amendment Request Form
    • Patient Grievance Form
    • Patient Rights & Responsibilities
    • Spanish – Patient Rights & Responsibilities
    • UBH Wellness Assessment Adult
    • UBH Wellness Assessment Youth

Release of Information

Online Forms

    • Release of Information
    • Revocation of Authorization for the Release of Information

PDF Forms

    • Printable Release of Information

Service Specific Forms

Counseling/Therapy

  • Intern Observation/Recording Consent

Medication Management

  • Transfer of Care Request (Online)
  • Transfer of Care Request Form (PDF)

Mother-Baby Program

  • Mother-Baby Group Agreement
  • Partner’s Group Agreement
  • Perinatal Safety Contract

Substance Use Disorder

  • SUD Evaluation/Assessment Forms
  • Opioid Treatment Options in MN & Overdose Prevention
  • SUD Orientation Forms and Information
  • Release of Information
  • Patient Health Care Bill of Rights – Minnesota Statutes
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866.938.4159

Main Office: 1900 Silver Lake Rd.
New Brighton, MN 55112

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