Client Forms

We use these forms to register our clients for our program. Please read, print, and complete the required forms prior to your first appointment. The forms are listed below with descriptions.  Please click the download buttons below to download forms that best fit your needs.

Form 1: Referral Intake

Please complete this form if you are a third party – i.e. another agency referring a client to Our KESMA Flame Lily LLC. Fill out the form and bring it to us in our office. You can also fax it to KESMA Flame Lily LLC  (763) 292-5653.

Form 2: Referral Intake Child/Teen

Please complete this form for children 0-18 years old. Fill out this form and fax it along with other required forms.

Adult Rehabilitative Mental Health Services

This section of the guide describes Adult Rehabilitative Mental Health Services or ARMHS.

Adult Mental Health Targeted Case Management

AMH-TCM services include developing a functional assessment and individual community support plan, referring and assisting.

Behavioral Health Home Services

Behavioral Health Home services provide an opportunity to build a person-centered system of care that achieves improved outcomes for individuals.


Coaching empowers and educates you on how to take charge of your career and achieve the success you’ve dreamed of.

Children & Families

Help a child achieve success in school when academic performance is impacted by the disorder.