External Referrals

This form is for professionals making an external referral to Solutions for services. We provide a variety of evidence-based outpatient therapy services for children, adolescents, adults, and families (see below). We also provide a number of outreach services. Some of these outreach services require Medicaid eligibility and justification for the service is determined through the Diagnostic Assessment process.

The first step in planning services always includes a meeting with the client and a mental health professional. The Diagnostic Assessment will be conducted at that time, unless one has been conducted within the past year.

For inquiries about the referral process or potential third party coverage for services (e.g., Medicaid) contact an Intake Specialist at (218) 287-4338.

Referring Party Information
Referring Party's Name *
Referring Party's Name
The name of the individual filling out this form.
Referring Party's Phone Number *
Referring Party's Phone Number
Client Information
Client Name *
Client Name
Client Date of Birth *
Client Date of Birth
Client Phone Number *
Client Phone Number
Available Clinical Information
Clinical Documentation *
Please provide information about any particular considerations, such as physical disability, preferred language, cultural factors, safety concerns, etc..
Services
Outpatient Therapy
Targeted Mental Health Case Management -MN Medicaid
Other Services
Include name and contact information/method.
Preferred location for services?
You may select multiple locations if applicable.