Mental Health Intake Forms

If you are new to Family Guidance and Therapy Center you will need to fill out some forms prior to starting treatment.

The following forms you fill out based on the type of appointment requested:

Child History - Treatment for a Minor Child
Couples History - Couples Therapy
Family History - Family Therapy
Patient History - Individual Therapy

The following forms are required and must be filled out prior to your treatment beginning. Please go through the form carefully. If there are any fields left blank on the following forms you will be asked to fill them out again.

Required for all new clients:

Privacy Policy
Informed Consent

Optional Forms

The Release of Information is an optional form that can be completed for your psychiatrist, any former therapists, or a parent/guardian that does not possess legal custody. Please complete as many releases as you feel are relevant. For example, a release of information for all current providers (psychiatrist, therapist, school, etc) or previous providers. A release of information is needed for anyone that does not have legal custody of your child. If you have questions about who to complete the Release of Information form for, please contact the FGTC office. To submit multiple releases, please go here after you complete the intake forms below.

The intake form process consists of 4 pages and could take up to 30 minutes to complete so make sure you have plenty of time before you begin.

All forms are HIPAA compliant and secure. However, in order to maintain compliance with HIPAA and keep your information safe, you can not save your forms and finish them later. Please go through all the forms and make sure you click 'Submit' at the end to turn them into the FGTC office.

Make sure you have any supporting records ready to upload.

Sign the COVID Waiver

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