CONTACT – Touch Point Health LLC

Touch Point Health LLC

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We are here to support you on your journey to recovery and independence.

2021 E Hennepin Ave Unit 100-1 Minneapolis, MN 55413
612-213-6893
Touchpointhealth1@gmail.com

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Empowering Recovery, Enabling Independence

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Contact Details

2021 E Hennepin Ave Unit 100-1 Minneapolis, MN 55413
612-213-6893
Touchpointhealth1@gmail.com

Hours

Monday – Friday 8:30 AM – 4:30 PM

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Referral Form- ARMHS

Referral Information

Referrals Name (required):

Client Information

Client Name (required):

DOB: (required)

PMI/ID: Put N/A if unknown (required)

Insurance Carrier: Put N/A if unknown (required)

Phone (required)

Address (required)

Are they receiving services with Touch Point Health? (required)

Yes No

Are they currently receiving ARMHS from another Provider: (required)

Yes No

If yes: What is the current ARMHS Providers Agency Name:

Are they currently residing in an IRTS facility, Crisis Home, or Hospital: (required)

Yes No

If Yes: What is the current IRTS facility, Crisis Home, or Hospital Name:

Are they on a Civil Commitment: (required)

Yes No

What areas do they need support in (Goals): (required)

Do they have a Staff preference: (required)

Male Female No Preference

Mental Health Information:

Do you currently have a Psychiatrist & Clinic: (required)

Yes No

If Yes: Name Psychiatrist & Clinic:

Do you have a Therapist & Clinic: (required)

Yes No

If Yes: Please name Therapist & Clinic

Clinical Documents:

Does the individual have a current DA within 12 months? (required)

Yes No

Please indicate Client's availability to schedule a Diagnostic Assessment with Clinician: (required)