If filling out forms digitally, you will need Adobe Acrobat Reader to properly sign documents. Otherwise, we encourage clients to print off and fill out documentation before their appointment. Forms are also available at locations and can be filled out in lobby.
Once forms are completed, please email them to email@example.com with the subject line being the name of the provider requesting the information. For any questions pertaining to a Release of Information, please contact our team at HIMdept@cmmhc.org or by calling 320.703.4352.
New Client Information
- Notice of Privacy Practices- English
- Notice of Privacy Practices – Somali – Ogaysiiska Habraaca Xafidida Xogta
- Notice of Privacy Practices – Spanish – Aviso de Prácticas de Privacidad
- Billing Policies – English
- Billing Policies – Somali – Siyaasadaha biilasha iyo macluumaadka khidmadda
- Billing Policies – Spanish – Políticas de facturación e información sobre honorarios
- Client Guidelines – English
- Client Guidelines – Somali – Tilmaamaha Macmiilka iyo Mas’uuliyadaha Balamaha Oogo Daaweynta
- Client Guidelines – Spanish – Lineamientos y responsabilidades del cliente para las citas de terapia
- Complaints & Grievances
- Patient Bill of Rights
- Therapist Rights – English
- Therapist Rights – Somali – Xuquuqda iyo Mas’uuliyadaha Daaweeyaha Terabiyada
- Therapist Rights – Spanish – Derechos y responsabilidades de los terapeutas
- Client Handbook – English
- Client Handbook – Somali – Buug-gacmeedka macmiilka
- Client Handbook – Spanish – Manual para clientes
- Sliding Fee Policy – English
- Sliding Fee Policy – Somali – Miisaanidda Khidmada La Qiimeeyo
- Sliding Fee Policy – Spanish – Escala móvil de honorarios
- Sliding Fee Scale – English
- Sliding Fee Scale – Somali – Barnaamijka Qadarka Khidmada Hoos Loo Dhigo
- Sliding Fee Scale – Spanish – Programa de escala móvil de honorarios
Forms for Ages 11 – 17
Forms for Ages 6 – 10
Consent and Release Forms
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Right to Privacy
Central Minnesota Mental Health Center supports every client’s right to privacy and it is the responsibility of everyone to protect it. Central Minnesota Mental Health Center’s clients have access to and control over their protected health information. Responsible use of clients’ protected health information by all employees at CMMHC will help improve health care by increasing trust in the system.
Together, Creating a Healthier Life
Do you or someone you know struggle with chemical or mental health symptoms? Do you want to reach out but aren’t sure where to turn?
We’re here to help.
Crisis Services are available 24/7, 365 at 320.253.5555.