Our office is closed to the public. We're operating via Telehealth.

Patient documents

For your convenience, below you will find our patient paperwork. Please feel free to complete the appropriate document(s) and return them to our office prior to your appointment.

Brookings Behavioral Health & Wellness

211 4th St.      Brookings, SD 57006

Ph: (605) 697-2850      Fax: (605) 697-2874

Email: sshulda @brookingsivycenter.org

If you have any questions, please do not hesitate to contact us.

New Patient Forms (pdf)


Release of Information (pdf)


Financial Eligibility FY21 (pdf)



If you are another office or facility and would like to refer your patient to our office, please fill out the form below. In order for our office to act on the referral we must have the requested forms attached. You will find the list of requested documents on the referral form. 

Thank you for your referral. We look forward to working with you and your patient. 

Referral Form (pdf)


Frequently Asked Questions


What insurances do you accept?

We accept several major insurances. We accept Medicare and Medicaid for our providers. We accept Medicaid for any of our staff (case managers and clinicians). No insurance - no problem.

What are the costs for services?

These costs displayed are a guideline. Please note that we provide services to everyone, regardless of their ability to pay. We accept most major insurances and offer a sliding scale fee based off of household size and income. Please contact our office for any questions or concerns you may have.

         Counseling Appointments

             Initial Appointment     $181.00 per hour

              Return Appointment  $162.00 per hour

        Medical Appointments

             Initial Appointment    $300.00 per hour

             Return Appointment  $150.00 per hour

How long do sessions last?

First sessions are typically 60 minutes long. Subsequent sessions may very depending on your treatment plan and availability. 

How frequently should I attend counseling?

Depending on your customized treatment plan, you may decide to meet weekly, biweekly, or monthly for 30-60 minutes on average. It may change throughout your treatment. We will help work with you and your schedule!

I work full-time, what are my options?

The first appointment with one of our staff members needs to be scheduled during our normal business hours 8am-5pm Monday through Friday but subsequent appointments can be coordinated with counselors availability. 

What is your privacy policy?

Our agency abides by HIPPA guidelines and policies. While filling out paperwork upon first session, a staff member will discuss our privacy policy with you and answer any specific questions you may have. Release of information forms are available for clients and may be revoked at any time.