Helpful Forms

          "He will bless, protect, and be gracious to you" - Numbers 6:24-26

Please select the appropriate intake form to submit for your/your child's new consultation -

Authorization to Disclose Information

If you would like us to coordinate care with your psychiatrist, primary care physician, or your child's school, etc - FHC will need you to complete an Authorization to Disclose Information Form. This will grant us/your therapist permission to do so.

Per company policy, clinicians or office staff are NOT permitted to speak to your attorneys with this form. All legal representatives must secure a subpoena to speak with a member of our practice. See our client agreement for associated fees for communicating with attorneys and related court retainer fees.

Record Requests

To begin a record request, please fill out our record release form to begin the process. There is a fee of $45 for the first 20-pages and $1 per page thereafter. You are allowed one free mental health record per year and there is NO fee for record requests made by 3rd party government agencies (i.e. Unemployment office, SSI, etc.)

Note: To download Adobe Acrobat Reader for free, click here.

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