Family Counseling Center
Creating an Affordable Path to Lifelong Mental Health
*Address: 1347 Grant Street Red Bluff, CA 96080  *Phone: 530-527-6702  *Email: info@fccredbluff.com
Family Counseling Center Address: 1347 Grant Street Red Bluff, CA 96080  Phone: 530-527-6702  Email: info@fccredbluff.com Developed by MNS WebDesigns

FORMS

Below are the forms for new clients to fill out. Here is a copy of our Privacy Practices Disclosure: Privacy Practices   These forms are required for all clients: Client Information Medical History If the person coming in for couseling is a minor, please print out and sign this form: Minor Client Consent If you are seeing Hillary, Mary, Jaye, or Janet, print and sign this form: Informed Consent, Licensed If you are seeing Jovita, Beverly, Matt or Ariel, print and sign this form: Informed Consent, Intern   If you are seeing a Trainee, print and sign this form: Informed Consent, Trainee   If you are going to be using a primary insurance, print and sign this form: Insurance Release   If you are on our sliding fee scale, please print and fill out this form: Income Verification
Family Counseling Center
*Address: 1347 Grant Street Red Bluff, CA 96080  *Phone: 530-527-6702  *Email: info@fccredbluff.com
Family Counseling Center Address: 1347 Grant Street Red Bluff, CA 96080  Phone: 530-527-6702  Email: info@fccredbluff.com Developed by MNS WebDesigns

FORMS

Below are the forms for new clients to fill out. Here is a copy of our Privacy Practices Disclosure: Privacy Practices   These forms are required for all clients: Client Information Medical History If the person coming in for couseling is a minor, please print out and sign this form: Minor Client Consent If you are seeing Hillary, Mary, Jaye, or Janet, print and sign this form: Informed Consent, Licensed If you are seeing Jovita, Beverly, Matt or Ariel, print and sign this form: Informed Consent, Intern   If you are seeing a Trainee, print and sign this form: Informed Consent, Trainee   If you are going to be using a primary insurance, print and sign this form: Insurance Release   If you are on our sliding fee scale, please print and fill out this form: Income Verification