Forms

Client Form Detail

Medical Details

If you are new to our medication management program please complete the two forms below, and bring them to your first appointment.

Record Detail

If you need all or part of your counseling record. ​Please allow 4-5 business days to process.

Insurance Update Form

Complete the form below if you are an existing client, or if you are a new client who has been instructed to provide additional insurance information.

Please note: These forms are in Portable Document Format (pdf) and require a pdf reader. If your computer does not have a pdf reader, you may download Adobe Reader X for free here.

Reader X download note: The download is preset to automatically include, for free, both the Google Chrome Internet Browser and the Google Toolbar for Internet Explorer.

These are optional and are NOT required to view and/or print Family Counseling Associates forms. If you do NOT want them included in your download, be sure to CLEAR the check box called “Yes, install Chrome as my default browser and Google Toolbar for Internet Explorer – optional.(32.11 MB)”.

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