Forms for ClientsIntake Paperwork:
Our desire is to provide you services as soon as possible. Please fill out all of the intake paperwork completely and send to either the Sartell, Brainerd, or Mankato office. 
Please fill out the insurance/payer form that matches your billing/payment method:
The following forms are only applicable to clients not billing insurance for sex offender treatment services:
Release of Information/Authorization Form:
In order for us to release information about an individual who has been seen at CORE, an appropriate authorization form must be completed. Please fill out the attached document and send it to either the Sartell, Brainerd, or Mankato office.
Notice of Privacy Practices:
For information regarding CORE's policies and practices to protect the privacy of patient health information, please see attached document.
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Forms for Referring PartiesTreatment Referral:
To refer a client for therapeutic services at CORE Professional Services, PA, please fill out the attached document and send it to either the Sartell, Brainerd, or Mankato office. Please note: Background information (court/police reports, Statement of Probable Cause, previous evaluations, progress notes, etc.) regarding reason for referral is required prior to scheduling assessments or sex offender treatment services. Please send this when making a referral.
Guarantor Letter:
In order for an agency/county to pay the cost of an individual's evaluation or treatment, this document needs to be filled out completely and sent to either the Sartell, Brainerd, or Mankato office.
Application for Sex Offender Program Access (SOTD Form):
This form is completed by the client's correction agent and must be returned to the treatment program prior to the commencement of treatment. Please fill out the attached document and send it to either the Sartell, Brainerd, or Mankato office.
Release of Information/Authorization Form:
In order for us to release information about an individual who has been seen at CORE, an appropriate authorization form must be completed. Please fill out the attached document and send it to either the Sartell, Brainerd, or Mankato office.
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Copyright 2020 CORE Professional Services, P.A. Frank F. Weber - All rights reserved.