Forms
Spero — or a specific therapist or mental health professional — will often ask that you complete certain forms prior to your appointment. They may be needed for insurance purposes, privacy, or to help us better address your mental health or therapy needs.
We’ve provided several forms online to save our therapy clients time in the office. All forms are located below in either PDF format to print and sign — which requires Mental Health Family Counseling Resources MN to view — or online versions, which can be completed and submitted electronically.
Please note, filling out these forms does not make you a client of Spero, you must call to set up an appointment at 507-451-2630 or 800-722-0590.
New Client Appointment Forms
Notice of Privacy Practices
New Client Questionnaire – Adult
New Client Questionnaire – Child and Adolescent
SDOH – Adult
SDOH Child & Adolescent
Insurance and Agreements Form
Release of Information
Telehealth Services Consent
Client Profile Form
PHQ-9 – Depression Screening – 18 & Older
PHQ-9A – Depression Screening – 12-17 Years Old
GAD-7 – Anxiety Screening – 12 years and Older
Vanderbilt ADHD Diagnostic Rating Scale – Parent (when appropriate)
Vanderbilt ADHD Diagnostic Rating Scale – Teacher (when appropriate)
Teletherapy/Telehealth Forms
Therapy Treatment Plan Signature Form
Therapy and Psychiatry – Staff Rights and Responsibilities
Group Teletherapy Confidentiality Agreement
Psychiatry – Consent to Obtain Medication History
Adult Mental Health Targeted Case Management (ATCM) Treatment Plan Signature Form
ARMHS Telehealth Signature Form
CTSS Telehealth Signature Form
Housing Programs Telehealth Signature Form
Children’s Mental Health Targeted Case Management (CTCM) Signature Form
Student Observation
Online Release of Information Forms
Referral Forms
Dialectical Behavior Therapy (DBT)
Dual Recovery Program
Dual Recovery
Authorization to Disclose Protected Health Information
Client Notice of Assessment Fee & Financial Responsibility
Confidentiality and Adult Protection Reporting
DAANES Acknowledgement Form
DRP Observation and Treatment with Intern Informed Consent
Adolescent Program Specific
Referral for Adolescent Substance Abuse Program
DRP Insurance Form for Adolescent Program
Adolescent Release of Information Example – Parent
Adolescent Release of Information Example – School
Adolescent Release of Information Example – SCHRC
Adolescent Release of Information Example – Self
Adult Program Specific
Adult Release of Information Example – SCHRC
Adult Release of Information Example – Self
Adult Release of Information Example – MN Adult Abuse Reporting Center
Safe Harbour
Crisis Response
Printable Forms
Release of Information
Directions for filling out a Release of Information form
Insurance Release
Consent to Obtain Medication History
Client Request to Obtain Personal Health Information