Forms to Complete for Couples or Family Therapy

Please complete the required fields and then submit on the documents below in order to setup a patient account. Upon receipt of your completed forms, we will contact you with an appointment if we have an opening at the time your application is processed. If you do not hear from us, it means that we were unable to find an appropriate placement, and we do recommend continuing your search for a provider.

During the first 30 days, appointments are given on a ‘first come, first served’ basis by the date your documents are received. We recommend calling our office at the beginning of each calendar month to update your continuing interest. Doing so moves your application to the current month’s list. Barring any insurance or treatment issues, anyone who contacts us and has an intake on file longer than 30 days will be placed in an opening if one is available at the time of their call. Additional forms may be requested at the time of placement with a therapist.

All Adults Must Each Fill out one of the Following:

Please indicate couples therapy or family therapy on the reason for treatment question at the top of page 3 and list the names of any other adults attending:

Beachside Intake and Medical History

After completing all of the required fields, a submit button will appear which will encrypt the document before sending.

Downloading the documents will ERASE your responses. There is a 60 minute time-out limit.

If you need help, 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.