Initial Intake Applications

All new clients are required to have intake forms completed and on file. Please complete the appropriate form according to the age of the individual seeking counseling services. You must complete the intake forms prior to getting an appointment.

Adult intake forms are for individuals age 18 and older.

Click to download the Adult Intake Form (English)

Click to download the Adult Intake Form (Spanish)

Youth intake forms are for those ages 4 – 17 years.

Click to download the Youth Intake Form (English)

Click to download Youth Intake  Form (Spanish)

*If you are seeking counseling for your child, please fill out a child intake form in addition to an adult intake packet. The information from both forms is needed for billing and demographic tracking purposes.

If you are seeking couples counseling, each person needs to complete an adult intake packet.

If you are seeking family counseling, please fill out an intake packet for each person who will be attending sessions.

Completed forms can be submitted via email or fax. Please email completed forms to Fcsreceptionist5@gmail.com or fax them to (801) 399-1640.