Counseling Documents

Adult Intake Form

Child Intake Form

Couples Intake Form

Consent to Release Information

Professional Disclosure & Informed Consent

Teletherapy Informed Consent

In-Person Services Informed Consent

Notice of Privacy Practices

Third Party Payment Consent

Name (required)

Phone Number (required)

Email (required)

What Time Frame Are You Available for Appointments? (required)

Please Choose A Location (required)

Please Choose A Preferred Therapist (required) See Our Therapists

Please share some of the circumstances bringing you to seek counseling (required)

I acknowledge that FRCS does not accept managed care reimbursement for
mental health services. Yes

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