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    • David Alter, PhD, LP
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    • Diane Tanning, RN, MS, L.Ac.
    • Lois Fischer MA, LMFT
    • Harriet Kohen, MSW, LICSW
    • Dr. Daniel Kohen, MD
    • Debbie Fischer, MA, LAMFT
    • Jessica Shaw, MA
    • Alecia Viera, PsyD, LP
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Intake Forms

Dr. David Alter

Please download and fill out Dr. David Alter's intake forms, and fax, email, or mail 2 days prior to your appointment.

Intake form in pdf  alter_300
  • Dr  Alter's Initial Psychotherapy Appointment Questionnaire
  • Dr  Alter's Registration Form - Getting to the Guts of What Matters
  • Dr  Alter's Neuro-behavioral Symptom Checklist
  • Dr  Alter's Record Release

Harriet Kohen's Intake Forms

Please download and fill out Harriet Kohen, MSW, LICSW's intake form and bring it with you to your child/teen's appointment.

Intake form in pdf HarrietKohen2014
  • Harriet Kohen's, MSW, LICSW Child Intake Form
  • Harriet Kohen's, MSW, LICSW Adolescent Intake Form
  • Harriet Kohen's, MSW, LICSW Consent for Treatment of a Minor

Dr. Daniel P. Kohen's Intake Forms

Please download and fill out Dr. Daniel P. Kohen, MD's intake form and bring it with you to your appointment.

Intake form in pdf DanKohen
  • Pediatric Pain Questionnaire
  • Pediatric Pain Questionnaire Adolescent
  • Pediatric Pain Questionnaire Parent
  • Child Health History
  • Child Pain Questionnaire
  • Teen Health History
  • Constipation and Soiling Questionnaire
  • Constipation and Soiling Guidelines
  • Enuresis Questionnaire
  • Parent Guidelines Enuresis
  • Headache Questionnaire
  • Rating Scale of Tic Disorders

 

Credit Card Payment Form

 

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Intake Forms

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10505 Wayzata Boulevard, #200, Minnetonka, MN 55305

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