Forms
If you are going to attend your first appointment at BHSI, you can send forms to us by mail, fax, or email.
Clinic addresses and fax numbers are listed at the bottom of this page.
To email forms:
1) Complete the online form(s) and then save each one to your device.
2) Click here to start an email to [email protected], then attach your forms and send.
Clinic addresses and fax numbers are listed at the bottom of this page.
To email forms:
1) Complete the online form(s) and then save each one to your device.
2) Click here to start an email to [email protected], then attach your forms and send.
General forms
Adult Intake Forms
Adolescent Intake Forms
Child Intake Forms
Other Forms
- BHSI Client Rights and Responsibilities
- Telehealth Consent Form
- Authorization to Release Information
- BHSI Statement of Privacy Practices
- Tips on Refilling Your Prescriptions
- E-Mail Authorization Form
Adult Intake Forms
- Adult Re-Open Form (use this instead of the Adult Intake Form if you have been to BHSI in the past)
- Adult Intake form
- Telehealth Consent Form
- Insurance form
- Insurance Payment Order
- Treatment Agreement
- Primary Care release of information
Adolescent Intake Forms
- Adolescent Intake Form
- PHQ-9
- Telehealth Consent Form
- Insurance form
- Insurance Payment Order
- Treatment Agreement
- Primary Care release of information
Child Intake Forms
- Child Intake Form
- Telehealth Consent Form
- Insurance form
- Insurance Payment Order
- Treatment Agreement
- Primary Care release of information
Other Forms
BHSI Eagan
3460 Washington Dr, Suite 200
Eagan MN 55122
Fax: (651) 769-6249
3460 Washington Dr, Suite 200
Eagan MN 55122
Fax: (651) 769-6249
BHSI Brooklyn Center
6300 Shingle Creek Parkway,
Suite 370
Brooklyn Center MN 55430
fax: (651) 769-6299
6300 Shingle Creek Parkway,
Suite 370
Brooklyn Center MN 55430
fax: (651) 769-6299
BHSI Golden Valley
8441 Wayzata Blvd, Suite 140
Golden Valley, MN 55426
Fax: (651) 769-6349
8441 Wayzata Blvd, Suite 140
Golden Valley, MN 55426
Fax: (651) 769-6349
BHSI North St Paul
2497 7th Ave E, Suite 101
North St Paul, MN 55109
Fax: (651) 769-6449
2497 7th Ave E, Suite 101
North St Paul, MN 55109
Fax: (651) 769-6449
BHSI Shakopee
327 S. Marschall Rd, Suite 250
Shakopee, MN 55379
Fax: (651) 769-6549
327 S. Marschall Rd, Suite 250
Shakopee, MN 55379
Fax: (651) 769-6549