In order for you to register to receive services at the Centers for Family Change* you need to:
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.
- Consent for Treatment
- HIPAA Privacy Notice
- Financial Policy
- Physician Release
- Teletherapy Consent
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.
- If the client is a child/teen age 11 to 17 please sign the Adolescent Privacy Form.
- If you are going to receive couples therapy please sign the Multiple Attendee Form
- Permission to Bill your Credit Card Form
- Please see the information below regarding credit card billing. If you want us to bill your credit card you must complete this form! We will not bill your credit card unless you complete this form
Do not complete the other Optional forms unless requested to do so.
If you do not wish to have your credit card information and do not want us bill your credit card you can enter a random string of digits and information instead of your actual credit card information. You do need to fill in this section in order to register, but we do not require that you provide your credit card information.
If you wish us to bill your credit card you must complete this information and then 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.