Documents/Forms

Acumen Brochure

Printable brochure to share with referrals, as needed to describe and outline services offered. 

Acumen Diary Card

DBT Diary card for Acumen Counseling Services clients.

Acumen Referral Form

Referrals for services from other providers are facilitated more quickly with this form.

Acumen Release of Information Form

The release of client information requires a written release of information.

Acumen Information Packet

This booklet contains important information, including:
 Information for Therapy Clients
 Confidentiality in Therapy
 HIPAA, Records and other Privacy Practices
 Access to Health Records Notice of Rights
 Minnesota Patients’ Bill of Rights

Adult Intake Packet

This packet contains a ‘Client Data Sheet ‘ to gain demographic information for minors, ‘Informed Consent to Treatment for Therapy Clients’, and an ‘Acknowledgement of Privacy Practices, HIPAA, Records other Privacy Practices’ form which must be completed prior to the first session.  

Minor Intake Packet

This packet contains a ‘Minor Data Sheet ‘ to gain demographic information for minors, ‘Informed Consent to Treatment for Parents of Minor Therapy Clients’, and an ‘Acknowledgement of Privacy Practices, HIPAA, Records other Privacy Practices’ form which must be completed prior to the first session.