Pre-Registration Form


We understand what it’s like to watch your child struggle at home, at school and in the community. Just like you, our dedicated professionals want the best for them. Whether your child lives with anxiety, depression, ADHD or another mental health issue, Family Service & Guidance Center is here to assess what’s going on and provide the appropriate treatment.

Pre-registration is the quickest, easiest way to get started. Once you complete and submit the pre-registration form, an FSGC staff member will be in touch soon by phone to arrange your first appointment.

Complete the information below. Be sure to click "Submit" to send your form to us. FSGC Admissions will contact you to set up your appointment. (NOTE: An asterisk * indicates required information.)

Insurance Information

Add your primary insurance company policy information below.

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Did you know?

FSGC’s Anxiety Treatment Program is one of just a handful across the entire Midwest and the only such program in a community mental health center in the country. The average length of service is just 4.4 months.