Forms

NorthStar Outpatient Release of Information

NorthStar Outpatient Policies

NorthStar Outpatient Policies & Fee Schedule

NorthStar Outpatient Medical Refill & CancelNo Show Policy

NorthStar Outpatient Consent to TreatClient Rights

NorthStar Outpatient Intake Form – new patient form

Practice Policy Contract – for new patients seeing Dr. Donald Roth, APNP

DISCLAIMER:

Providers at NorthStar Mental Health are here to help you and your family as best they can and sometimes that requires additional assistance outside of therapy sessions.  If you are looking to become a new patient at Northstar and are aware that you will need paperwork completed by the provider please keep in mind the following:

Providers are not able get involved in divorce/custody/court/legal cases, compose letters nor complete any paperwork requiring their opinions/recommendations until the patient is well established. This process generally involves regular appointments for 2-3 months (or to the providers discretion) so that a professional opinion/recommendation may be properly and confidently formed.  Other requests of this nature requiring the same consideration include but are not limited to, workers comp, therapy animals, FMLA, Disability, etc. As some of these requests are quite time consuming and in depth process, if applicable, please be sure to mention the necessity of the latter when setting up an initial appointment, to be sure the provider has the time and ability to adequately meet your needs in addition to their current caseload.