Grand Island Mental Health Therapy
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​Please Note: If attending Grand Island Mental Health & Medical Clinic for the first time or returning after more than one year absence, you will need to complete an intake form and informed consent form. You can fill out these forms on this website, fill out in our office 30 minutes before your scheduled time, or call to get forms mailed to you. Any other forms needed will be filled out when you have your first appointment.  If you have any questions please feel free to come early to your appointment and ask for assistance from our receptionist or your therapist.

Are you a new client?

If you are wanting to be scheduled with a provider in our office, welcome and thank you for choosing Grand Island Mental Health and Medical Clinic!  The first step is to fill out the Client Information Form.  This form is important because it introduces you to us and it emails our front office staff to let us know that you would like to be scheduled.  It takes about 5-10 minutes to fill out the form.  To get started, please click on the button below.
Online Client Information Form

Intake Forms

Prepare for these forms to take approximately 10 minutes to complete. In completing these forms before your appointment you are allowing the time in your first visit to be spent working directly on current issues with your provider since the main necessary information has already been gathered by these forms
Online Adult Intake Form
Downloadable Adult Intake Form
Online Minor Intake Form
Downloadable Minor Intake Form

Informed Consent Forms

An informed consent form must be completed prior to your first appointment with our office. These forms also give you helpful information regarding your rights and responsibilities, our current fees, office policies, etc. 
Online Informed Consent Form
Downloadable Informed Consent Form

Release Forms

These forms are used to authorize our release of information to entities besides yourself and are optional. 
Online Release of Confidential Information Form
Downloadable Release of Confidential Information Form
Online Release of Schedule Information
Downloadable Release of Schedule Information

Other Forms 

These forms are only as needed and are not required 
Online Financial Hardship Sliding Scale Application
Downloadable Financial Hardship Sliding Scale Application
Satisfaction Survey
90 Day Assessment
NE Advanced Directive Healthcare Form
NE Power of Attorney Health Care Form

Cost of Services

Fees for 2023
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