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
- Permission to Bill Credit Card
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
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.