Family Counseling Center
Creating an Affordable Path to Lifelong Mental Health
*Address: 1112 Washington Street Red Bluff, CA 96080 *Phone: 530-527-6702 *Email: info@fccredbluff.org
Our Main Location 1112 Washington Street, Red Bluff Our Original Location: Address: 1347 Grant Street Next to the Hope Chest Our Corning Office 175 Solano Street, Corning

FORMS

Below are the forms for new clients to fill out. Here is a copy of our Privacy Practices Disclosure: Privacy Practices These forms are required for all clients: Client Information Medical History If the person coming in for counseling is a minor, please print out and sign this form: Minor Client Consent If you are seeing a licensed therapist, print and sign this form: Informed Consent, Licensed If you are seeing an associate therapist print and sign this form: Informed Consent, Associate If you are seeing a Trainee, print and sign this form: Informed Consent, Trainee If you are going to be using a primary insurance, print and sign this form: Insurance Release If you are on our sliding fee scale, please print and fill out this form: Income Verification
CONTACT US AT ANY OF OUR 3 LOCATIONS
Our Main Location 1112 Washington Street, Red Bluff Our Original Location: Address: 1347 Grant Street Next to the Hope Chest Our Corning Office 175 Solano Street, Corning
Phone: 530-527-6702 Email: info@fccredbluff.org Developed by MNS WebDesigns
CONTACT US AT ANY OF OUR 3 LOCATIONS
Family Counseling Center

FORMS

Below are the forms for new clients to fill out. Here is a copy of our Privacy Practices Disclosure: Privacy Practices These forms are required for all clients: Client Information Medical History If the person coming in for counseling is a minor, please print out and sign this form: Minor Client Consent If you are seeing a licensed therapist, print and sign this form: Informed Consent, Licensed If you are seeing an associate therapist print and sign this form: Informed Consent, Associate If you are seeing a Trainee, print and sign this form: Informed Consent, Trainee If you are going to be using a primary insurance, print and sign this form: Insurance Release If you are on our sliding fee scale, please print and fill out this form: Income Verification
*Address: 1112 Washington Street Red Bluff, CA 96080 *Phone: 530-527-6702 *Email: info@fccredbluff.org