Mente Salus Psychological Services, LLC

A private practice serving the Chippewa Valley

Have questions? Call:

715-839-7240

REQUEST INFORMATION

FORMS

If you are a new client, please print and complete the following forms and bring them to your first therapy session with your insurance card. Do not email completed forms.

 

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

 
Pre-employment evaluations: Use the link to the Intake History form above but obtain your Registration Form from the agency requesting your eval.  You do not need a separate Authorization form.
 
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Contact me today to request an appointment or to obtain additional information

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