Family Behavioral Health - Potential Client
If you are interested in therapy (we do not provider medication management) for yourself or someone you have guardianship of, please fill out the potential client form and we will be in contact with you.
1. Please complete the potential client form by clicking next.
2. We will verify your mental health benefits and will communicate your financial responsibility.
3. If you decide to move forward we will assign you to a provider and schedule your intake and assessment appointment when availability arises.
Page 1 of 2
Never submit passwords through Google Forms.
This form was created inside of 🌿Family Behavioral Health.