Creating an Affordable Path to Lifelong Mental Health
*Address:1112 Washington Street Red Bluff, CA 96080 *Phone: 530-527-6702 *Email: info@fccredbluff.org
Our Main Location1112 Washington Street, Red BluffOur Original Location:Address: 1347 Grant Street Next to the Hope ChestOur Corning Office 175 Solano Street, Corning
FORMS
Below are the forms for new clients to fill out.Here is a copy of our Privacy Practices Disclosure:Privacy PracticesThese forms are required for all clients:Client InformationMedical HistoryIf the person coming in for counseling is a minor, please print out and sign this form:Minor Client ConsentIf you are seeing a licensed therapist, print and sign this form:Informed Consent, LicensedIf you are seeing an associate therapist print and sign this form:Informed Consent, AssociateIf you are seeing a Trainee, print and sign this form:Informed Consent, TraineeIf you are going to be using a primary insurance, print and sign this form:Insurance ReleaseIf you are on our sliding fee scale, please print and fill out this form:Income Verification
Our Main Location1112 Washington Street, Red BluffOur Original Location:Address: 1347 Grant Street Next to the Hope ChestOur Corning Office 175 Solano Street, Corning
Phone: 530-527-6702 Email: info@fccredbluff.orgDeveloped by MNS WebDesigns
CONTACT US AT ANY OF OUR 3 LOCATIONS
FamilyCounselingCenter
FORMS
Below are the forms for new clients to fill out.Here is a copy of our Privacy Practices Disclosure:Privacy PracticesThese forms are required for all clients:Client InformationMedical HistoryIf the person coming in for counseling is a minor, please print out and sign this form:Minor Client ConsentIf you are seeing a licensed therapist, print and sign this form:Informed Consent, LicensedIf you are seeing an associate therapist print and sign this form:Informed Consent, AssociateIf you are seeing a Trainee, print and sign this form:Informed Consent, TraineeIf you are going to be using a primary insurance, print and sign this form:Insurance ReleaseIf you are on our sliding fee scale, please print and fill out this form:Income Verification
*Address: 1112 Washington Street Red Bluff, CA 96080 *Phone: 530-527-6702 *Email: info@fccredbluff.org