Recovery And Empowerment Handbook
Collects demographic information, reasons for seeking treatment, appointment availability, and more
Describes how we handle behavior problems in case they occur at one of our offices.
Explains how we handle appointment cancellations.
Describes regular fees for different services.
Explains you rights and responsibilities as a Family Service Association Client
By signing this form you authorize us to disclose specific information to another person or entity.
Sheet with information and policies on how to contact your counselor in case of a crisis or emergency
Explains how your protected health information is handled. It also explains your rights as a Family Service Association client
Complete this form if interested in this service. It will allow the program supervisor to determine if the client is elgible or not.
Please read each of these carefully. Put your name, or the name of your child if he/she is the one receiving services, where it says "client name". If you are looking for services for your child please sign where it says "Parent/guardian signature" and if the child is 12 or older have him/her sign where it says "Client signature". If you are 18 or older and are looking for services for yourself please sign where it says "Client signature" and leave the field "Parent/Guardian signature" empty.
If you are getting ready for your first appointment you can download and print these forms. Please, do not forget to bring the signature pages with you to the appointment so that they can be added to your file.