fcf intake form
So that we can better serve you, we ask that all clients fill out our intake form. Please fill out the basic information online intake form below and select “SUBMIT”. Then click here to download the printable medically confidential intake form and bring it with you to your first appointment OR go over it with your therapist during your first video session (if you have filled out and submitted the basic information online form, you do not need to fill out the FIRST PAGE of the download form as they are essentially the same. We look forward to meeting with you!
By clicking on the "SUBMIT" button above, you understand that it is customary to pay for services when rendered. You accept full responsibility for payment of any balance incurred for services. You further understand that there will be a $50 cancellation fee without a 24-hour notice (except in the case of an emergency).