Registration

Please speak to one of our intake specialists before registering on our secure portal. If you have already spoken with an intake specialist, please complete the steps below.

In order for you to register to receive services at the Centers for Family Change* you need to:

1. Register on our Secure Platform

At the end of registering, you will have to create a username and a password (both must be at least 8 characters in length). You will then be transferred to your patient portal where you can complete our registration forms.

2. Complete the Required Forms

  1. Consent for Treatment
  2. HIPAA Privacy Notice
  3. Financial Policy
  4. Physician Release
  5. Teletherapy Consent
  6. Permission to Bill Credit Card

3. Read Our Policies

Please read our policies carefully. By signing the Consent for Treatment Form you are agreeing to adhere to Centers for Family Change policies. Be sure to raise any questions about our policies with your therapist.

Our Policies

4. Optional Forms

  1. If the client is a child/teen age 11 to 17 please sign the Adolescent Privacy Form.
  2. If you are going to receive couples therapy please sign the Multiple Attendee Form

Do not complete the optional forms unless requested to do so.

5. Permission to Bill your Credit Card

You need to provide your credit card information in this section in order to register. However, we will only bill your credit card if you complete the Permission to bill your Credit Card form.

Trouble Registering?

If you are having difficulty using our online registration system, please call us and one of our staff will assist you.

(630)586-9991

*Centers for Family Change does not consider you a client until you have started therapy (had your initial session) with one of our therapists.

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