Please ensure Javascript is enabled for purposes of website accessibility Consent for Services - Woodland Centers

Consent for Services

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Parent/Legal Guardian (If applicable)
By signing, I acknowledge that I am authorizing for Woodland Centers to provide mental health /substance use services. Woodland Centers may send my insurance company any information that is needed to determine payment for services. This may include substance use information. I give my insurance company permission to send payment directly to Woodland Centers. I may apply for a reduced fee if I live in Big Stone, Chippewa, Kandiyohi, Lac qui Parle, Meeker, Renville, or Swift County. I understand that to apply for a reduced fee, I must submit to Woodland Centers information on my family size and verification of my gross income within 30 days. I understand that I am financially responsible for my bill.
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Help is available 24/7. Call the Crisis phone line at 1-800-432-8781
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