Forms to Complete for Couples or Family Therapy

Please complete and submit documents below in order to setup a patient account. Once they are received, you will be placed on our appointment list. We will call you as soon as we have a suitable appointment available.

If you need further assistance, please contact us. We are happy to provide any further assistance you may need, and we look forward to seeing you at Beachside Adult & Family Therapy.

Insured’s name on front page & partner’s signature on last:

Agreement for Additional Adult Attendance

Each Adult Must Fill out the Following: