Online New Patient Registration Form

If you are a new patient at Family Counseling Associates and have a first appointment already scheduled, please complete the New Patient Registration form below using Adobe eSign before your first appointment.  This form MUST be completed 24 hours prior to your first appointment.  If you can not complete this online form ahead of time, and you have an in-office appointment, we recommend arriving 15-20 minutes before your first scheduled appointment and you can complete a paper form in our office.

*This form is designed to be completed using a computer (mobile phone and tablet users may experience some complications).

Prior to your first appointment, you may wish to also review our Notice of Privacy Practices and Policies Statement.