Authorization Request for
New Outpatient Mental Health Service
Click here to open and print or save the Authorization Request for New Outpatient Mental Health Service form.
This request is to only be used for NEW SERVICES for a client. Requests for additional services should be directed to TEAM using the "Authorization Request for Continued Sessions" at www.team-mn.com.
Please print clearly. Incomplete or illegible forms can not be processed.
Please fax completed forms to TEAM at: 651-642-1809
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