1st Appointment

Please click on each form and print. Bring the completed forms to your intial visit. If you prefer to send them in advance you can send them as an attachment to our office staff at office@fcbtf.com

Client Information Form - this form provides us with your personal conctact and billing information.

Parent Questionnaire - this is a detailed questionnaire to assist parents in organizing their observations, along with key aspects of their child's history. 

Office Policies and Procedures - this document reviews all the essential elements of our service agreement with you. Please sign and return the last page.

Consent for Counseling or Psychological Testing - this form along with your signature gives your consent for FCBTF to provide counseling and/or psychological testing services to your child. 

Patient Release of Information Form - Please make sure you initial (do not check) all lines that pertain to your child. At a minimum we ask that you allow us to coordinate care with your pediatrician. On the bottom portion please make sure you initial all areas as a "yes" as this information is contained in your child's progress notes. On the back side, please indicate "yes" to those areas that pertain to your child. 

Family Center by the Falls

8401 Chagrin Rd, Suite 14B

Chagin Falls, OH 44023

440-543-3400 phone

440-543-2287 fax