Online Intake Form

If you are a new patient at Family Counseling Associates and have a first appointment already scheduled, please complete the intake form below using Adobe eSign before your first appointment.  This form is designed to be completed using a computer and mobile phone users may experience complications.

If you can not complete this online form ahead of time, we recommend arriving 15-20 minutes before your first scheduled appointment and you can complete a paper form in our office.

*Please note at the bottom of the form, there is the option to upload a picture of your insurance card.