Please call our main number and speak to the receptionist about your specific needs and insurance. If you have a specific therapist you would like to work with, please give this information to the receptionist. Each therapist has different areas of expertise and our receptionist will be happy to match you to an appropriate provider. Please fill out the following form and mail, email, fax, or deliver in person prior to your first appointment. You can email the receptionist at email@example.com.
Download INITIAL INTAKE FORM FOR ADULT CLIENTS
Download INITIAL INTAKE FORM FOR MINOR CLIENTS
DEPARTMENT OF CORRECTIONS REFERRAL
Please call and ask for the program coordinator or email at firstname.lastname@example.org. She/he will be happy to take your information over the phone to set up an appointment. Please have the following information ready: Name, Phone, DC#, Supervising Officer, Program Type, Funding Status. Our office will need the following documents prior to the client’s first appointment: court documents, probation orders, referral form, and police/sheriff report.
PSYCHOLOGICAL OR PSYCHOSEXUAL EVALUATION REFERRAL
Please call and ask for the program coordinator or email at email@example.com. She/he will be happy to take your information over the phone to set up an appointment. We will need documents prior to setting the appointment. These may include: DCF abuse records, court orders and/or reviews, predisposition report/study, victim statement/s, CPT medical report, case plan and updates, previous treatment reports/summaries, medical records, police/sheriff reports, any past mental health-related evaluations/assessments.