Intake Forms – Make an Appointment

Welcome to Desert View Family Counseling Service. We sincerely appreciate your interest in our agency and wish to serve you in the most effective way possible. We have provided many of the forms you need to begin therapy on this page and they should be completed before scheduling an appointment. In an effort to save you time in the office, please download all Intake forms, fill them out and upload them here or bring your completed forms with you to your first session. Not to worry, should you forget your forms, we do maintain copies at the office but will be unable to begin your session until all forms are completed.

The information requested of you within the Intake paperwork may seem extensive. Please know that we are only asking for information that is necessary for either your insurance company or to see if you are eligible for funding assistance to help towards your services.

Paperwork required

You must bring in your current Medicaid or your insurance card.

Grant Assistance

Depending on your income or size of household, you may qualify for our sliding fee scale or grant assistance. YOU MUST BRING IN PROOF OF INCOME TO QUALIFY.

Custody/ Guardianship

Children and adolescents must have a parent (or legal guardian) present to sign for treatment. If parents are separated, going through a divorce, or divorced then you must provide a “parenting plan”. If you are a foster parent or legal guardian, then you must provide this documentation as well, no exceptions!

Confidentiality

We cannot share information with family members or allow extended family to make or change appointments. Only the client, parent or legal guardian can do so.

Cancellation Policy

If you need to cancel an appointment, please notify us at least 24 hours before the scheduled appointment date. If we do not receive a notification to cancel, a minimum-$35 fee will be assessed.

Medicaid Clients

No show/cancellation fees do not apply to Medicaid clients; however, if you miss two consecutive visits you will be referred out.

Upload Forms

Download and save forms to your desktop prior to them filling out.

If you just enter your information directly into the forms (and do not save them on your desktop first) unfortunately, the data does save.

Download and save our forms onto your desktop.
Fill out your information and then save.
When returning, upload your SAVED documents into the email and send them.

Forms

Please be sure to save your forms before sending them to us. Some of these forms require Adobe Acrobat Reader in order for you to add a digital signature(*). If you do not have Adobe Acrobat Reader you can download a free version here

Child (12 & under)

Adolescent (13 – 17)

Adult (18+)

Misc.