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Prior to your scheduled appointment please print and complete the following admission forms and bring them with you to your admission appointment.
Client Admission Forms:
Child Consent to Treatment Form
Client Information Face Sheet
Client Admission Information
Family Service & Guidance Center Disclosure Instructions
Client Responsibility and Acknowledgement Form
In addition to the forms listed above, you will need to bring:
- Completed Child Behavior Checklist (CBCL). Child Welfare Contractors should have copies in your office. For an additional copy, please contact FSGC at 785.232.5005
- Previous Treatment Information - Reports from previous providers are always helpful
- Copy of the insured's insurance card
We look forward to serving your needs. Feel free to contact our Admission office if you have questions. 785.232.5005
If you experience difficulties opening any forms, please contact our admission office. We will be happy to email or fax a copy of the forms. |
