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Counseling Service Forms

Referral Form- Therapeutic Counseling (Fillable)

  • January 9, 2018
  • Family Resource Center

To see a preview, click the word "Download" to the left!
This is a fillable form that needs to be filled in by you, your current counseling service, DFCS, or other agency and emailed/faxed to us in order for you to be considered for therapeutic counseling. Once you've typed in the spaces, remember to "save as" your name so that it can be emailed to us.

Adult Counseling Intake Packet

  • January 6, 2018
  • Family Resource Center

To see a preview, click the word "Download" to the left!
Adults who have been accepted into our counseling program need to fill in this 7-page form and submit it by following the instructions within the form.

Adult Welcome Packet for Counseling Services

  • Family Resource Center

To see a preview, click the word "Download" to the left!
This 5-page booklet needs to be read by all clients before acceptance into the Therapeutic Counseling Services of the Family Resource Center. It explains all of our policies and procedures.

Child-Adolescent Counseling Intake Form

  • January 4, 2018
  • Family Resource Center

To see a preview, click the word "Download" to the left!
Legal guardians of adolescents accepted into our counseling program need to fill in this 9-paged form and submit it to us by following the instructions in the form.

Child-Adolescent Welcome Packet for Counseling Services

  • Family Resource Center

To see a preview, click the word "Download" to the left!
Legal guardians of children/adolescents accepted into our counseling program need to read through this 6-page booklet that explains our policies and procedures.

HIPPA Privacy Practices

  • January 1, 2018
  • Family Resource Center

To see a preview, click the word "Download" to the left!
By federal and state law, PCAH is required to ensure that your private health information (PHI) is kept private. This Notice explains when, why, and how PCAH would use and/or disclose your private health information.

What are Adverse Childhood Experiences? (ACEs)

  • Family Resource Center

This is a great infographic that clearly explains ACEs. "Adverse Childhood Experiences" is the term given to describe all types of abuse, neglect and other traumatic experiences that occur to individuals under the age of 18.

ACEs and Brain Development

  • Family Resource Center

This is a great 1-page infographic that explains all the areas affected by Adverse Childhood Experiences (ACEs).