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Intake Process
When you schedule a session either at our office location or online, you need to be aware that there are some documents that will
need to be completed prior to your session. The following forms can be downloaded and either printed and faxed to 605-718-7595 or completed
electronically and emailed to forms@serenitymentalhealth.com. All forms are Microsoft®
compatible documents.
To begin, complete the following three documents
HIPAA Privacy Practices Documents
Notice of Privacy Practices
Privacy Practices Acknowledgement
Release of Information
Next Steps
After you have called or emailed to schedule an appointment at the office or an online session, you will be asked to complete
the intake process. This can be completed either online, or by downloading the documents, and either printing, completing, and faxing them to
605-718-7595, or complete them electronically and email them to forms@serenitymentalhealth.com.
Downloadable Intake Forms
Client Information Form
Insurance Information
Infromation and Consent
Or, Use our online intake process
As an alternative, we have developed a comprehensive online intake process. To take advantage of this streamlined solution, you must first create a
user account by clicking Login and then click Sign Up. Click here to get started. Once you have a user account, you will see a number of options
under Member Services on the right side of each page. After you've created an account and are logged in, you can click Intake Forms to begin.
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6613 Eastridge Road
Black Hawk, SD 57718
1-888-347-7560

Diana Smith, MA, LPC-MH, CCDC III
Diana owns and operates Serenity Mental Health Services and is licensed by the National Board of Certified Counselors. License number is LPC-MH2025 and she follows the ethical guidelines described by the NBCC found below and at their web site www.nbcc.org/webethics2.
Diana is a member of the National Board for Certified Counselors, Certification Number 43911.
In addition, she is also a member of the American Counseling Association, Member ID# 5140627.
Online counseling can help you right now. Research has made it clear that this manner of offering therapy is effective and those who've experienced it have said they would seek it out again.
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