Intake Paperwork
Client Registration
Client(s) that are 18 years old or older, should fill out the the adult form.
Marital therapy clients should print and fill out one form for each person to complete.
Credit Policy
Our primary concern is your welfare and providing you with the highest quality service.
However, the financial aspect of your care is also important, so please refer to our policies below.
Physicians Release
Physical and emotional issues often influence each other, and to provide the best care, physicians and therapists need to exchange records or communicate with each other.
In order to do so, we must have your written consent.
In addition to the intake paperwork, please print and fill out the appropriate questionnaire from the options below.
Client Questionnaires
Adult
Client(s) that are 18 years old or older, should fill out the the adult form.
Marital therapy clients should print and fill out one form for each person to complete.
Adolescent
For clients that are ages 11-17 years old.
Some parts of the form require parents to fill out information.
Child
For clients ages 10 years old and under.
Some parts of the form require parents to fill out information.
Please print and complete the Registration, Credit Policy, and Physician’s Release forms, as well as the questionnaire and read the HIPPA form below before arriving at FCC.
Additional Forms
HIPPA Notice
This HIPPA Notice form is only for your records.