Duluth Counseling Center

Client Forms

Links to our commonly requested forms are below. If the form you need is not on this list, please call our office at (218) 249-0595. To submit your completed form, either email it to info@duluthcounselingcenter.com, or bring a paper copy to your next appointment.

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

Duluth Counseling Center Authorization to Release Confidential Information Form (ROI)

Request an Appointment

Same day or next day appointments available.

Enter you name

Date of Birth

Phone (XXX) XXX - XXXX

How did you hear about us?

If you selected "Other", can you share how you found out about us?

Please enter the name of your insurance company as it appears on your card. (ex. Blue Cross, Blue Sheild)

IN PERSON OR BY VIDEO

Anything we should know

Please select a service

Please select one of the following

Select Preferred Time

Preferred Date

Please briefly explain what you're looking to get support for. This information helps ensure that we pair you with a therapist who best fits your needs.

Please do not submit any Protected Health Information (PHI).

10 + 1 =

You can usually be seen this week

Depending on availability we offer same-day or next-day appointments. There is no long waitlist and no referral required for most plans.

Request an Appointment

Insurance & fees